Active NPI
Shanda Walker, MS CCC-SLP
- Speech-Language Pathologist
- Tyler, TX
National Provider Identifier
1104297092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 107505
- Practice address
- 401 E Front St
Suite 123
Tyler, TX 75702-8213 - Phone
- (903) 531-2581
- NPI assigned
- Oct 17, 2015
- 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 | 107505 | TX | Primary |
Addresses
Primary practice location
401 E Front St
Suite 123
Tyler, TX 75702-8213
Mailing address
6181 FM 346 E
None
Tyler, TX 75703-8133
Phone (214) 683-4420
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 |
|---|---|---|---|
| 107505 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445040000000",
"number": "1104297092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6181 FM 346 E",
"address_2": "NONE",
"city": "TYLER",
"state": "TX",
"postal_code": "757038133",
"telephone_number": "214-683-4420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 E FRONT ST",
"address_2": "SUITE 123",
"city": "TYLER",
"state": "TX",
"postal_code": "757028213",
"telephone_number": "903-531-2581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKER",
"first_name": "SHANDA",
"credential": "MS CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-17",
"last_updated": "2015-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "107505",
"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 Oct 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.