Active NPI
Vixen A Wilson-Thomas, SLP
- Speech-Language Pathologist
- St Petersburg, FL
National Provider Identifier
1124663349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA-15282
- Practice address
- 2570 Granada Cir W
St Petersburg, FL 33712-3928 - Phone
- (727) 430-3981
- NPI assigned
- Nov 12, 2019
- 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 | SA-15282 | FL | Primary |
Addresses
Primary practice location
2570 Granada Cir W
St Petersburg, FL 33712-3928
Mailing address
2570 Granada Cir W
St Petersburg, FL 33712-3928
Phone (727) 430-3981
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 |
|---|---|---|---|
| SA-15282 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573516800000",
"number": "1124663349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2570 GRANADA CIR W",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337123928",
"telephone_number": "727-430-3981"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2570 GRANADA CIR W",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337123928",
"telephone_number": "727-430-3981"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON-THOMAS",
"first_name": "VIXEN",
"middle_name": "A",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-12",
"last_updated": "2019-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA-15282",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.