Individual provider Active NPI

Stacy Velasquez, SLP

  • Speech-Language Pathologist
  • Waco, TX
National Provider Identifier
1194329979
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
13720 Issued in TX
Practice address
1105 Jefferson Ave
Waco, TX 76701-1212
Phone
(254) 752-3451
Fax
(254) 756-3133
NPI assigned
Nov 23, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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 13720 TX Primary

Addresses

Primary practice location

1105 Jefferson Ave
Waco, TX 76701-1212

Mailing address

110 S 12TH St
Waco, TX 76701-1810
Phone (254) 752-3451

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201203000324 TX Practitioner - Qualified Speech Language Pathologist 9537570197 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Heart of Texas Region MHMR Center CurrentSince Nov 9, 2020 Accepting new patients

Locations

1105 Jefferson Ave
Waco, TX 76701
Phone (254) 297-7000

110 S 12th St
Waco, TX 76701
Phone (254) 297-7124

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": "1606089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1194329979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S 12TH ST",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767011810",
            "telephone_number": "254-752-3451",
            "fax_number": "254-756-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 JEFFERSON AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767011212",
            "telephone_number": "254-752-3451",
            "fax_number": "254-756-3133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELASQUEZ",
        "first_name": "STACY",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "13720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; 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.