Individual provider Active NPI

Mary Scoville, M.ED., CCC-SLP

  • Speech-Language Pathologist
  • Wilmington, NC
National Provider Identifier
1487801353
Registry record updated Sep 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
5238 Issued in NC
Practice address
4130 Oleander Dr
Wilmington, NC 28403
Phone
(910) 679-8385
Fax
(910) 679-8387
NPI assigned
Aug 22, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2018

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 5238 NC Primary

Addresses

Primary practice location

4130 Oleander Dr
Wilmington, NC 28403

Mailing address

4130 Oleander Dr
Wilmington, NC 28403-6843
Phone (910) 679-8385

Other practice location 1

185 Charlois Blvd
Winston Salem, NC 27103-1521
Phone (336) 725-0222

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
Credentials
Master of Education

Practice roles

OrganizationSpecialtyStatusNew patients
Speechcenter LLC, D/B/a Sidekick Therapy Partners Speech-Language Pathologist Past Accepting new patients
Coastline Therapy Group, LLC Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536105600000",
    "number": "1487801353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036843",
            "telephone_number": "910-679-8385",
            "fax_number": "910-679-8387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28403",
            "telephone_number": "910-679-8385",
            "fax_number": "910-679-8387"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "185 Charlois Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031521",
            "country_code": "US",
            "telephone_number": "336-725-0222",
            "fax_number": "336-725-0454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCOVILLE",
        "first_name": "MARY",
        "credential": "M.ED., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-22",
        "last_updated": "2018-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "5238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; 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.