Individual provider Active NPI

Angela V Thornton, SLP

  • Speech-Language Pathologist
  • Philadelphia, MS
National Provider Identifier
1114727062
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
S5176 Issued in MS
Practice address
921 W Beacon St
Philadelphia, MS 39350-3229
Phone
(601) 650-0002
NPI assigned
Mar 18, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X S5176 MS Primary

Addresses

Primary practice location

921 W Beacon St
Philadelphia, MS 39350-3229

Mailing address

921 W Beacon St
Philadelphia, MS 39350-3229
Phone (601) 650-0002

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250423001829 MS Practitioner - Qualified Speech Language Pathologist 8123543089 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S5176MSMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Performance Therapy LLC CurrentSince Feb 20, 2025 Accepting new patients

Locations

119 Colony Crossing Way
Ste 820
Madison, MS 39110
Phone (769) 289-2890

921 W Beacon St
Philadelphia, MS 39350
Phone (601) 650-0002

1058 Holland Ave
Philadelphia, MS 39350
Phone (601) 650-0002

Organizations & group practices 1

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": "1742256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1114727062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 W BEACON ST",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393503229",
            "telephone_number": "601-650-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 W BEACON ST",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393503229",
            "telephone_number": "601-650-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORNTON",
        "first_name": "ANGELA",
        "middle_name": "V",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-18",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S5176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; 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.