Individual provider Active NPI

Kathryn Ruth Wilson, M.A., CCC-SLP

  • Speech-Language Pathologist
  • Roseville, CA
National Provider Identifier
1285912204
Registry record updated Oct 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
20735 Issued in CA
Practice address
151 N Sunrise Ave
Suite 1105
Roseville, CA 95661-2924
Phone
(916) 771-8255
NPI assigned
Jul 25, 2011
Last updated
Oct 9, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X S3598 MS
Speech-Language Pathologist 235Z00000X 20735 CA Primary
Speech-Language Pathologist 235Z00000X 06878 MD
Speech-Language Pathologist 235Z00000X SLP000582 DC
Speech-Language Pathologist 235Z00000X SA12159 FL

Addresses

Primary practice location

151 N Sunrise Ave
Suite 1105
Roseville, CA 95661-2924

Mailing address

151 N Sunrise Ave
Suite 1105
Roseville, CA 95661-2924
Phone (916) 771-8255

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 Arts

State licenses

LicenseStateTypeSpecialty
06878MDMDMental Health Counselor
20735CAMDSpeech-Language Pathologist
SLP000582DCMDSpeech-Language Pathologist
SA12159FLMDSpeech-Language Pathologist
S3598MSMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381276800000",
    "number": "1285912204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N SUNRISE AVE",
            "address_2": "SUITE 1105",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612924",
            "telephone_number": "916-771-8255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N SUNRISE AVE",
            "address_2": "SUITE 1105",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612924",
            "telephone_number": "916-771-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KATHRYN",
        "middle_name": "RUTH",
        "name_prefix": "Ms.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-25",
        "last_updated": "2013-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S3598",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "20735",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "06878",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "DC",
            "license": "SLP000582",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA12159",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.