NPIMap

Individual provider Active NPI

Heather Stallings, MCD

  • Speech-Language Pathologist
  • Madison, AL
National Provider Identifier
1508140401
Registry record updated Jun 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
3454 Issued in AL
Practice address
103 Intercom Dr
Suite C
Madison, AL 35758-2640
Phone
(256) 464-9464
Fax
(256) 325-9469
NPI assigned
Oct 11, 2011
Last updated
Jun 4, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X PCET001675 GA
Speech-Language Pathologist 235Z00000X SLP007875 GA
Speech-Language Pathologist 235Z00000X 3454 AL Primary

Addresses

Primary practice location

103 Intercom Dr
Suite C
Madison, AL 35758-2640

Mailing address

103 Intercom Dr
Suite C
Madison, AL 35758-2640
Phone (256) 464-9464

Other identifiers 1

IdentifierTypeStateIssuer
003126198AMedicaidGA

Other names 1

  • Heather Ketchum Former name

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
3454ALMDOrthodontics and Dentofacial Orthopedic Dentist
PCET001675GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Speech LLC Speech-Language Pathologist PastSince Mar 1, 2020 Accepting new patients
Madison Speech Associates, Inc 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370304000000",
    "number": "1508140401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 INTERCOM DR",
            "address_2": "SUITE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357582640",
            "telephone_number": "256-464-9464",
            "fax_number": "256-325-9469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 INTERCOM DR",
            "address_2": "SUITE C",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357582640",
            "telephone_number": "256-464-9464",
            "fax_number": "256-325-9469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLINGS",
        "first_name": "HEATHER",
        "credential": "MCD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-11",
        "last_updated": "2013-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "PCET001675",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP007875",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AL",
            "license": "3454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003126198A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "KETCHUM",
            "credential": "MCD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Madison, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.