Individual provider Active NPI

Beth M Thornton, SLP

  • Speech-Language Pathologist
  • Waterford, WI
National Provider Identifier
1235356130
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2551-154 Issued in WI
Practice address
1701 Sharp Rd
Waterford, WI 53185-5214
Phone
(262) 534-7297
Fax
(262) 534-7257
NPI assigned
Apr 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 2551-154 WI Primary

Addresses

Primary practice location

1701 Sharp Rd
Waterford, WI 53185-5214

Mailing address

W330S8190 Country LN S
Mukwonago, WI 53149-9258
Phone (262) 853-4498

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141112002568 WI Practitioner - Qualified Speech Language Pathologist 9335361005 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paxxon Healthcare Services LLCGroup PAC ID 8325959554, 153 clinicians

Practice addresses (Care Compare)

2210 Dufek Dr
Manitowoc, WI 54220-9356
Phone (920) 652-0534

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Paxxon Healthcare Services LLC Speech-Language Pathologist CurrentSince Mar 13, 2023 Accepting new patients
Paxxon Healthcare Services LLC CurrentSince Mar 13, 2023 Accepting new patients
Powerback Rehabilitation LLC Speech-Language Pathologist PastSince Jun 27, 2019 Accepting new patients

Locations

2210 Dufek Dr
Manitowoc, WI 54220
Phone (715) 574-4724

1111 E Capitol Dr
Shorewood, WI 53211
Phone (262) 293-3207

Organizations & group practices 3

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": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235356130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W330S8190 COUNTRY LN S",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "531499258",
            "telephone_number": "262-853-4498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SHARP RD",
            "city": "WATERFORD",
            "state": "WI",
            "postal_code": "531855214",
            "telephone_number": "262-534-7297",
            "fax_number": "262-534-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORNTON",
        "first_name": "BETH",
        "middle_name": "M",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "2551-154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.