Individual provider Active NPI

Mindy Hodgell

  • Speech-Language Pathologist
  • Fort Walton Beach, FL
National Provider Identifier
1356755995
Registry record updated Jun 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SZ6670 Issued in FL
Practice address
930 Mar Walt Dr
Suite D
Ft. Walton Beach, FL 32547-8306
Phone
(850) 226-8279
NPI assigned
Jun 11, 2014
Last updated
Jun 11, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SZ6670 FL Primary

Addresses

Primary practice location

930 Mar Walt Dr
Suite D
Ft. Walton Beach, FL 32547-8306

Mailing address

930 Mar Walt Drive Suit D
Fort Walton Beach, FL 32547
Phone (850) 226-8279

Other identifiers 1

IdentifierTypeStateIssuer
SZ6670OtherFLLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230328001297 WI Practitioner - Qualified Speech Language Pathologist 7810361169 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SZ6670FLMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Aegis Group Practice LLC Speech-Language Pathologist CurrentSince Mar 2, 2023 Accepting new patients
Empowerme Rehabilitation, LLC Speech-Language Pathologist CurrentSince Jul 20, 2023 Accepting new patients
Aegis Group Practice LLC Speech-Language Pathologist Current Accepting new patients
Empowerme Rehabilitation, LLC Speech-Language Pathologist CurrentSince Jul 20, 2023 Accepting new patients
Aegis Group Practice LLC Speech-Language Pathologist CurrentSince Mar 2, 2023 Accepting new patients

Locations

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1356755995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 MAR WALT DRIVE SUIT D",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "telephone_number": "850-226-8279",
            "fax_number": "850-226-8326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 MAR WALT DR",
            "address_2": "SUITE D",
            "city": "FT. WALTON BEACH",
            "state": "FL",
            "postal_code": "325478306",
            "telephone_number": "850-226-8279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGELL",
        "first_name": "MINDY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SZ6670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "SZ6670",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.