Active NPI
Gwendolyn Emerson, MA CCC-SLP
- Speech-Language Pathologist
- Frederick, MD
National Provider Identifier
1073121901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 03432
- Practice address
- 194 Thomas Johnson Dr Ste B
Frederick, MD 21702-4683 - Phone
- (301) 418-6434
- Fax
- (240) 566-3888
- NPI assigned
- Jul 16, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 03432 | MD | Primary |
Addresses
Primary practice location
194 Thomas Johnson Dr Ste B
Frederick, MD 21702-4683
Mailing address
9101 Wesleyan Rd Ste 100
Indianapolis, IN 46268-3103
Phone (800) 603-6046
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03432 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594857600000",
"number": "1073121901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9101 WESLEYAN RD STE 100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462683103",
"telephone_number": "800-603-6046",
"fax_number": "317-884-3388"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "194 THOMAS JOHNSON DR STE B",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217024683",
"telephone_number": "301-418-6434",
"fax_number": "240-566-3888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EMERSON",
"first_name": "GWENDOLYN",
"credential": "MA CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-16",
"last_updated": "2020-07-16",
"certification_date": "2020-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "03432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.