Stephanie Pieroni Oliver, MS, CCC-SLP

Key facts

NPI: 1326219585
Entity type: Individual (NPI type 1)
Primary specialty: Speech-Language Pathologist 235Z00000X
License: S2766 (MS)
Practice address: 1635 Boling St
Jackson, MS 39213-4418
Phone: (601) 366-0123
Fax: (601) 366-0649
NPI assigned: Mar 17, 2008
Sex: Female
Sole proprietor: Yes

Organizations & group practices 2

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.

Willowood Developmental Center Developmentally Disabled Services Day Training Agency · Jackson, MS · NPI 1174991855

NPD (past)
Willowood Developmental Center Intellectual and/or Developmental Disabilities Residential Treatment Facility · Jackson, MS · NPI 1831243070

NPD (past) SPEECH-LANGUAGE PATHOLOGIST

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Master of Science

State licenses

License	State	Type	Specialty
S2766	MS	MD	Speech-Language Pathologist

Practice roles

Organization	Specialty	Status	New patients
Willowood Developmental Center		Past	Accepting new patients
Willowood Developmental Center	Speech-Language Pathologist	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Speech-Language Pathologist	235Z00000X	S2766	MS	Yes

Addresses

Primary practice location

1635 Boling St
Jackson, MS 39213-4418

Mailing address

1635 Boling St
Jackson, MS 39213-4418
Phone (601) 366-0123

Other identifiers

Identifier	Type	State	Issuer
9015618	Medicaid	MS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 17, 2008.

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205712000000",
    "number": "1326219585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 BOLING ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134418",
            "telephone_number": "601-366-0123",
            "fax_number": "601-366-0649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 BOLING ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392134418",
            "telephone_number": "601-366-0123",
            "fax_number": "601-366-0649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "STEPHANIE",
        "middle_name": "PIERONI",
        "name_prefix": "Mrs.",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-17",
        "last_updated": "2008-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S2766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9015618",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

All providers in Jackson, MS · Speech-Language Pathologist in Mississippi

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.