Active NPI
Cristy Woodland, MS, SLP INTERN
- Speech-Language Pathologist
- Tyler, TX
National Provider Identifier
1104014109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 118080
- Practice address
- 100 E Ferguson St Ste 1204
Tyler, TX 75702-5700 - Phone
- (903) 509-2040
- Fax
- (855) 587-4499
- NPI assigned
- Oct 4, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | 34204 | TX | |
| Speech-Language Pathologist | 235Z00000X | 118080 | TX | Primary |
Addresses
Primary practice location
100 E Ferguson St Ste 1204
Tyler, TX 75702-5700
Mailing address
207 S Ponsard St
Troup, TX 75789-2164
Phone (936) 465-6194
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34204 | TX | MD | General Practice Dentistry |
| 118080 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623974400000",
"number": "1104014109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 S PONSARD ST",
"city": "TROUP",
"state": "TX",
"postal_code": "757892164",
"telephone_number": "936-465-6194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E FERGUSON ST STE 1204",
"city": "TYLER",
"state": "TX",
"postal_code": "757025700",
"telephone_number": "903-509-2040",
"fax_number": "855-587-4499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODLAND",
"first_name": "CRISTY",
"credential": "MS, SLP INTERN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-04",
"last_updated": "2021-06-18",
"certification_date": "2021-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "TX",
"license": "34204",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "118080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.