Individual provider Active NPI

Carla M Wiksell, M.A. CCC-SLP

  • Speech-Language Pathologist
  • Chattanooga, TN
National Provider Identifier
1093738569
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP0000001023 Issued in TN
Practice address
600 N. Holtzclaw - Suite 200
Chattanooga, TN 37404-1240
Phone
(423) 622-6900
Fax
(423) 622-4834
NPI assigned
Jul 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP0000001023 TN Primary
Speech-Language Pathologist 235Z00000X SLP003415 GA

Addresses

Primary practice location

600 N. Holtzclaw - Suite 200
Chattanooga, TN 37404-1240

Mailing address

600 N. Holtzclaw - Suite 200
Chattanooga, TN 37404-1240
Phone (423) 622-6900

Other identifiers 3

IdentifierTypeStateIssuer
4640001OtherTNUNITEDHEALTHCARE ID#
3060846OtherTNBCBST ID #
3060846MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130814000836 TN Practitioner - Qualified Speech Language Pathologist 6709028194 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
1023TNMDMarriage & Family Therapist
SLP003415GAMDSpeech-Language Pathologist
SP0000001023TNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Speech and Hearing Center Speech-Language Pathologist CurrentSince Mar 16, 2013 Accepting new patients
Signal Centers Inc Speech-Language Pathologist CurrentSince Jan 1, 2025 Accepting new patients

Locations

600 N Holtzclaw Ave
Ste 200
Chattanooga, TN 37404
Phone (423) 622-6900

6016 Shallowford Rd
Ste 1500
Chattanooga, TN 37421

2212 Encompass Dr
Ste 148
Chattanooga, TN 37421
Phone (423) 622-6900

2217 Encompass Dr
Ste 148
Chattanooga, TN 37421

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1093738569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N. HOLTZCLAW - SUITE 200",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374041240",
            "telephone_number": "423-622-6900",
            "fax_number": "423-622-4834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N. HOLTZCLAW - SUITE 200",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374041240",
            "telephone_number": "423-622-6900",
            "fax_number": "423-622-4834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIKSELL",
        "first_name": "CARLA",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "SP0000001023",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP003415",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE ID#",
            "identifier": "4640001",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST ID #",
            "identifier": "3060846",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3060846",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • 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.