Active NPI
Katherine Coolidge Wilson
- Speech-Language Assistant
- Carrollton, TX
National Provider Identifier
1174001440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- 39157
- Practice address
- 1000 W Crosby Rd Ste 136
Carrollton, TX 75006-6904 - Phone
- (972) 237-0100
- NPI assigned
- Jul 30, 2018
- Last updated
- Jul 30, 2018
- 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 Assistant | 2355S0801X | 39157 | TX | Primary |
Addresses
Primary practice location
1000 W Crosby Rd Ste 136
Carrollton, TX 75006-6904
Mailing address
8613 Southwestern Blvd Apt 824
Dallas, TX 75206-8248
Phone (832) 276-8419
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 |
|---|---|---|---|
| 39157 | TX | MD | Speech-Language Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CKC Holdings LLC | Past | Accepting new patients | |
| CKC Holdings LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532908800000",
"number": "1174001440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8613 SOUTHWESTERN BLVD APT 824",
"city": "DALLAS",
"state": "TX",
"postal_code": "752068248",
"telephone_number": "832-276-8419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 W CROSBY RD STE 136",
"city": "CARROLLTON",
"state": "TX",
"postal_code": "750066904",
"telephone_number": "972-237-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KATHERINE",
"middle_name": "COOLIDGE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-30",
"last_updated": "2018-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "TX",
"license": "39157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carrollton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.