Gold Star Pediatric Speech Therapy

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

GOLD STAR PEDIATRIC SPEECH THERAPY

Practice address

283 Ashpole TRL
Clayton, NC 27520-1774

Phone

(336) 587-6902

NPI assigned

Jan 3, 2023

Organization subpart

No

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

Authorized official

Name

Kanessia Shepard, CCC-SLPNPI 1992781868

Title

Speech Pathologist

Phone

(336) 587-6902

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kanessia Shepard, MA, CCC-SLP

  • Speech-Language Pathologist
  • Upper Marlboro, MD
  • NPI 1992781868
  NPD Authorized official

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

{
    "created_epoch": "1672704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1316650674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "283 ASHPOLE TRL",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275201774",
            "telephone_number": "336-587-6902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 ASHPOLE TRL",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275201774",
            "telephone_number": "336-587-6902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLD STAR PEDIATRIC SPEECH THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-03",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "SHEPARD",
        "authorized_official_first_name": "KANESSIA",
        "authorized_official_title_or_position": "SPEECH PATHOLOGIST",
        "authorized_official_telephone_number": "336-587-6902",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://goldstarspeech.clientscure.me",
            "affiliation": "N",
            "endpointDescription": "business websit",
            "address_1": "283 Ashpole Trl",
            "city": "Clayton",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275201774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Samuel L Goodson, BS, LMBT
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• Speech-Language Pathologist in Clayton, NC
• Providers in Clayton, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.