Active NPI
Kathryn M. Wilson
- Speech-Language Pathologist
- Port Charlotte, FL
National Provider Identifier
1427209923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA 5039
- Practice address
- 115 Leland St SW
Port Charlotte, FL 33952-9130 - Phone
- (941) 626-1443
- NPI assigned
- Oct 2, 2008
- Last updated
- Oct 2, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA 5039 | FL | Primary |
Addresses
Primary practice location
115 Leland St SW
Port Charlotte, FL 33952-9130
Mailing address
115 Leland St SW
Port Charlotte, FL 33952-9130
Phone (941) 626-1443
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA 5039 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222905600000",
"number": "1427209923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 LELAND ST SW",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339529130",
"telephone_number": "941-626-1443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 LELAND ST SW",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339529130",
"telephone_number": "941-626-1443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KATHRYN",
"middle_name": "M.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-02",
"last_updated": "2008-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA 5039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Charlotte, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.