Merrie G Pendergrass, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

3730 Blair Dr
Lsuhsc-School of Allied Health Professionals
Shreveport, LA 71103-4602

Phone

(318) 632-2030

Fax

(318) 675-5666

NPI assigned

Jul 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lsu Health Sciences Center Shreveport Faculty Group Practice

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1013374222
  Medicare reassignment NPD
• Louisiana State University Health Sciences Center Shreveport

  • Multi-Specialty Clinic/Center
  • Shreveport, LA
  • NPI 1790720738
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1063435451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3730 BLAIR DR",
            "address_2": "LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONALS",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034602",
            "telephone_number": "318-632-2030",
            "fax_number": "318-675-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3730 BLAIR DR",
            "address_2": "LSUHSC-SCHOOL OF ALLIED HEALTH PROFESSIONALS",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034602",
            "telephone_number": "318-632-2030",
            "fax_number": "318-675-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRASS",
        "first_name": "MERRIE",
        "middle_name": "G",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174173",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pelican Bayou Counseling Agency Inc.
• Omar Alejandro Pena Ruiz, DDS
• Faith Pena
• Lea Bonifacio Penales, MD
• Emily Barnett Pendarvis, MD
• Karen M'Liss Pendleton, M.D.
• Rodney La'Ree Pendleton, D.D.S.
• Glenis Joyce Penn
• Lisa Harrison Penn, CAC
• Robert L Penn, M.D.

• Speech-Language Pathologist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.