Active NPI
Eileen L Wallace
- Speech-Language Pathologist
- Bowie, MD
National Provider Identifier
1073239240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 02805
- Practice address
- 2701 Lyn PL
Bowie, MD 20715-2362 - Phone
- (301) 602-9121
- NPI assigned
- Oct 18, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 02805 | MD | Primary |
Addresses
Primary practice location
2701 Lyn PL
Bowie, MD 20715-2362
Mailing address
2701 Lyn PL
Bowie, MD 20715-2362
Phone (301) 602-9121
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02805 | MD | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666051200000",
"number": "1073239240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 LYN PL",
"city": "BOWIE",
"state": "MD",
"postal_code": "207152362",
"telephone_number": "301-602-9121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 LYN PL",
"city": "BOWIE",
"state": "MD",
"postal_code": "207152362",
"telephone_number": "301-602-9121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "EILEEN",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-18",
"last_updated": "2022-10-18",
"certification_date": "2022-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MD",
"license": "02805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.