Mary Mellencamp

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

114667 Issued in TX

Practice address

4402 Williams Dr Ste 115
Georgetown, TX 78628-1388

Phone

(832) 655-3754

NPI assigned

Jun 6, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jacqueline Kozak

  • Occupational Medicine Clinic/Center
  • Georgetown, TX
  • NPI 1699482448
  NPD
• Allied Therapies of Texas, PLLC

  • Multi-Specialty Clinic/Center
  • Copperas Cove, TX
  • NPI 1164009254
  NPD (past)

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1295394088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 CULLEN AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787572529",
            "telephone_number": "832-655-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 WILLIAMS DR STE 115",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281388",
            "telephone_number": "832-655-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLENCAMP",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-06",
        "last_updated": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "114667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mary@allcaretherapiesgt.com",
            "affiliation": "Y",
            "affiliationName": "All Care Therapies of Georgetown, PLLC",
            "address_1": "4402 Williams Dr Ste 115",
            "city": "Georgetown",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786281388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Deborah Meeker, P.T.
• Anya Meeks
• Sammie Mees, DC
• Adam Melcher
• Melissa L Gould LLC
• Ellen Clarice Melton, PHD, LPC
• Travis Mendenhall
• Devina Monique Mendez, PTA
• Crystal Maddox Mendl, RN
• Kimberly Lynne Menzie, O.D.

• Speech-Language Pathologist in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.