Active NPI
Devlin Wilde, CCC-SLP
- Speech-Language Pathologist
- Tuckasegee, NC
National Provider Identifier
1164825121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 9692
- Practice address
- 557 Cedar Creek Farm Rd
Tuckasegee, NC 28783-9677 - Phone
- (828) 554-5105
- NPI assigned
- Oct 6, 2014
- Last updated
- Oct 6, 2014
- Sex
- Male
- 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 | 9692 | NC | Primary |
Addresses
Primary practice location
557 Cedar Creek Farm Rd
Tuckasegee, NC 28783-9677
Mailing address
557 Cedar Creek Farm Rd
Tuckasegee, NC 28783-9677
Phone (828) 554-5105
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412553600000",
"number": "1164825121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "557 CEDAR CREEK FARM RD",
"city": "TUCKASEGEE",
"state": "NC",
"postal_code": "287839677",
"telephone_number": "828-554-5105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "557 CEDAR CREEK FARM RD",
"city": "TUCKASEGEE",
"state": "NC",
"postal_code": "287839677",
"telephone_number": "828-554-5105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDE",
"first_name": "DEVLIN",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-06",
"last_updated": "2014-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NC",
"license": "9692",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.