Active NPI
Carolyn M McIlwain, CCC-SLP
- Speech-Language Pathologist
- Coffeyville, KS
National Provider Identifier
1306017694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1261
- Practice address
- 1400 W 4TH St
Coffeyville, KS 67337-3306 - Phone
- (620) 252-1505
- NPI assigned
- Mar 14, 2008
- Sex
- Female
- Sole proprietor
- No
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 | 1261 | KS | Primary |
Addresses
Primary practice location
1400 W 4TH St
Coffeyville, KS 67337-3306
Mailing address
710 Keith Blvd
Coffeyville, KS 67337-1024
Phone (918) 766-5411
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1261 | KS | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306454400000",
"number": "1306017694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 KEITH BLVD",
"city": "COFFEYVILLE",
"state": "KS",
"postal_code": "673371024",
"telephone_number": "918-766-5411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 W 4TH ST",
"city": "COFFEYVILLE",
"state": "KS",
"postal_code": "673373306",
"telephone_number": "620-252-1505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCILWAIN",
"first_name": "CAROLYN",
"middle_name": "M",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-14",
"last_updated": "2011-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "KS",
"license": "1261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coffeyville, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.