Landon Leigh Wallis, MS,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

S3022 Issued in MS

Practice address

112 Old Lake CV
Batesville, MS 38606-7637

Phone

(662) 891-2029

NPI assigned

Jul 20, 2007

Last updated

Jul 19, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Landon Leigh Rutherford Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Northwest Ms Speech & Hearing, LLC

  • Speech-Language Pathologist
  • Batesville, MS
  • NPI 1710239843
  NPD (past) Authorized official

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1396945986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 OLD LAKE CV",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "386067637",
            "telephone_number": "662-891-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 OLD LAKE CV",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "386067637",
            "telephone_number": "662-891-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "LANDON",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "MS,CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-20",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S3022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0020229",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LANDON",
            "last_name": "RUTHERFORD",
            "middle_name": "LEIGH",
            "prefix": "MRS.",
            "credential": "MS,CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Harold Keith Waldrip
• Walgreen Co (wALGREENS # 11289)
• Amy Kathleen Walker
• Tyrongilia Quereese Walton, DNP
• Alec Tristan Whalen, PMHNP
• Marianne Day Wharton, CFNP
• Elizabeth White
• Brittany Leigh Wiggins, FNP-BC

• Speech-Language Pathologist in Batesville, MS
• Providers in Batesville, MS by specialty
• Speech-Language Pathologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; 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.