Active NPI
Mary Kristina Mathis, M.A./CCC-SLP
- Speech-Language Pathologist
- Winter Haven, FL
National Provider Identifier
1548565005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA6634
- Practice address
- 625 Overlook Dr
Winter Haven, FL 33884-1626 - Phone
- (863) 318-1315
- NPI assigned
- Jan 14, 2011
- 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 | SA6634 | FL | Primary |
Addresses
Primary practice location
625 Overlook Dr
Winter Haven, FL 33884-1626
Mailing address
625 Overlook Dr
Winter Haven, FL 33884-1626
Phone (863) 318-1315
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA6634 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294963200000",
"number": "1548565005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 OVERLOOK DR",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338841626",
"telephone_number": "863-318-1315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 OVERLOOK DR",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338841626",
"telephone_number": "863-318-1315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "MARY",
"middle_name": "KRISTINA",
"credential": "M.A./CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-14",
"last_updated": "2011-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA6634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.