Active NPI
Mary L Culkin
- Speech-Language Pathologist
- Wilkes Barre, PA
National Provider Identifier
1104967934
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SL 001508 L
- Practice address
- 71 North Franklin St
Wilkes Barre, PA 18701 - Phone
- (570) 829-2453
- Fax
- (570) 829-2462
- NPI assigned
- Feb 12, 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 | SL 001508 L | PA | Primary |
Addresses
Primary practice location
71 North Franklin St
Wilkes Barre, PA 18701
Mailing address
13 Parklane North
Mountaintop, PA 18707
Phone (570) 829-2453
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001867920 0002 | Medicaid | PA |
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 |
|---|---|---|---|
| SL 001508 L | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104967934",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 PARKLANE NORTH",
"city": "MOUNTAINTOP",
"state": "PA",
"postal_code": "18707",
"telephone_number": "570-829-2453",
"fax_number": "570-829-2462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 NORTH FRANKLIN ST",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "18701",
"telephone_number": "570-829-2453",
"fax_number": "570-829-2462"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CULKIN",
"first_name": "MARY",
"middle_name": "L",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL 001508 L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001867920 0002",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.