Susan Taylor Wallace

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2112 Issued in NC

Practice address

3409 Connection Dr
Fayetteville, NC 28311-0151

Phone

(910) 309-4089

Fax

(910) 488-1816

NPI assigned

Jun 12, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370217600000",
    "number": "1366646457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3409 CONNECTION RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283110151",
            "telephone_number": "910-822-1318",
            "fax_number": "910-488-1816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 CONNECTION DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283110151",
            "telephone_number": "910-309-4089",
            "fax_number": "910-488-1816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SUSAN",
        "middle_name": "TAYLOR",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-12",
        "last_updated": "2013-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "2112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Verneica Ann Walker, RN
• Walkthrough Therapy, PLLC
• Deborah Greene Wall, LCSW
• Kelsi Noelle Wallace, OT
• Samantha Anne Wallace, MA, CCC-SLP
• Tamika Shavone Wallace, LCSW- A
• Rolf Bolin Wallin, MD
• Katina Walline, PA-C
• Walmart Neighborhood Market
• Mary M. Walsh, OTR/L, CHT

• Speech-Language Pathologist in Fayetteville, NC
• Providers in Fayetteville, 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 Jun 3, 2013; 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.