Active NPI
Tracie Lynn Wilson, M.S. CCC-SLP
- Speech-Language Pathologist
- Mt Pleasant, SC
National Provider Identifier
1194288225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6050
- Practice address
- 2070 S Smokerise Way
Mt Pleasant, SC 29466-8635 - Phone
- (602) 717-6346
- NPI assigned
- Apr 6, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 6050 | SC | Primary |
Addresses
Primary practice location
2070 S Smokerise Way
Mt Pleasant, SC 29466-8635
Mailing address
2070 S Smokerise Way
Mt Pleasant, SC 29466-8635
Phone (602) 717-6346
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6050 | SC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554508800000",
"number": "1194288225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2070 S SMOKERISE WAY",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294668635",
"telephone_number": "602-717-6346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2070 S SMOKERISE WAY",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294668635",
"telephone_number": "602-717-6346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "TRACIE",
"middle_name": "LYNN",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-06",
"last_updated": "2019-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "SC",
"license": "6050",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.