Individual provider Active NPI

Mackenzie Wysong, SLP

  • Speech-Language Pathologist
  • Delaware, OH
National Provider Identifier
1548749609
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
494 W Central Ave
Delaware, OH 43015-1470
Phone
(740) 369-3650
NPI assigned
Aug 9, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

494 W Central Ave
Delaware, OH 43015-1470

Mailing address

494 W Central Ave
Delaware, OH 43015-1470
Phone (740) 369-3650

Other practice location 1

3940 N Hampton Dr
Powell, OH 43065-8442
Phone (614) 789-4473

Other identifiers 1

IdentifierTypeStateIssuer
0364590MedicaidOH

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Delaware Speech & Hearing Center Multi-Specialty Past Accepting new patients
The Delaware Speech and Hearing Center Multi-Specialty 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": "1533772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1548749609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "494 W CENTRAL AVE",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430151470",
            "telephone_number": "740-369-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "494 W CENTRAL AVE",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430151470",
            "telephone_number": "740-369-3650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3940 N Hampton Dr",
            "address_purpose": "LOCATION",
            "city": "Powell",
            "state": "OH",
            "postal_code": "430658442",
            "country_code": "US",
            "telephone_number": "614-789-4473",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYSONG",
        "first_name": "MACKENZIE",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-09",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0364590",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Delaware, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; 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.