Dana N Canninmulhearn
Individual provider Active NPI Speech-Language Pathologist · Winston Salem, NC
NPI 1639656309 · NPPES record last updated Jul 10, 2023
Key facts
- NPI
- 1639656309
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 11832 (NC)
- Practice address
- 1448 Ebert St
Winston Salem, NC 27103-5002 - Phone
- (336) 582-0081
- NPI assigned
- Jul 25, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221031002089 | NC | Practitioner - Qualified Speech Language Pathologist | 8628445897 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11832 | NC | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kidology, Inc | Current |
Accepting new patients | |
| The Speech Lady, PLLC | Speech-Language Pathologist | Past | Accepting new patients |
Locations
1244 N Flint St
Lincolnton, NC 28092
Phone (704) 740-0676
711 W Independence Blvd
Mount Airy, NC 27030
Phone (855) 983-0488
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 11832 | NC | Yes |
Addresses
Primary practice location
1448 Ebert St
Winston Salem, NC 27103-5002
Mailing address
1448 Ebert St
Winston Salem, NC 27103-5002
Phone (336) 582-0081
Other providers in Winston Salem, NC
- Claudia Campos
- Raul Canchari Ames
- Candicares, PLLC
- Rae Ellen Canfield
- Thomas Woodward Cann III
- David Wayne Cannon
- Harris Arthur Cannon
- Karen Saville Cannon
- Michael Louis Cannon
- Sydney Thomas Cannon
All providers in Winston Salem, NC · Speech-Language Pathologist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.