Active NPI
Dara Childers, MA, CCC-SLP
- Speech-Language Pathologist
- Hickory, NC
National Provider Identifier
1073659926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5827
- Practice address
- 2121 12TH Ave NE
Hickory, NC 28601-3187 - Phone
- (828) 381-1203
- NPI assigned
- Jan 29, 2007
- 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 | 5827 | NC | Primary |
Addresses
Primary practice location
2121 12TH Ave NE
Hickory, NC 28601-3187
Mailing address
PO Box 1366
Icard, NC 28666-1366
Phone (828) 381-1203
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7412147 | Medicaid | NC |
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 |
|---|---|---|---|
| 5827 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598486400000",
"number": "1073659926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1366",
"city": "ICARD",
"state": "NC",
"postal_code": "286661366",
"telephone_number": "828-381-1203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 12TH AVE NE",
"city": "HICKORY",
"state": "NC",
"postal_code": "286013187",
"telephone_number": "828-381-1203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDERS",
"first_name": "DARA",
"credential": "MA, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2020-08-27",
"certification_date": "2020-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "5827",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7412147",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hickory, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.