Melanie Wallace, MED

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

11874 Issued in NC

Practice address

7700 US Highway 158
Stokesdale, NC 27357-9346

Phone

(336) 643-6301

NPI assigned

Mar 2, 2019

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

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2015

Medicare assignment

May accept Medicare assignment

Group practices

Calso Physical Therapy LLCGroup PAC ID 0547523045, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

Practice roles

Locations

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.

• Calso Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Greensboro, NC
  • NPI 1790289387
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1551484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551484800000",
    "number": "1447718077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2504 WESTMORELAND DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274085323",
            "telephone_number": "336-707-3370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 US HIGHWAY 158",
            "city": "STOKESDALE",
            "state": "NC",
            "postal_code": "273579346",
            "telephone_number": "336-643-6301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2504 Westmoreland Dr",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274085323",
            "country_code": "US",
            "telephone_number": "336-707-3370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MELANIE",
        "credential": "MED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-02",
        "last_updated": "2019-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "11874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Safe Pasag Transport LLC
• Jennah Kaileen Steelman, FNP-BC
• Stokesdale Family Care, PC
• Stokesdale Family Pharmacy
• Stokesdale Family Pharmacy Inc.
• Ashley Marie Waterloo

• Speech-Language Pathologist in Stokesdale, NC
• Providers in Stokesdale, 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 Mar 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.