Active NPI
Diane Wallace, SLP
- Speech-Language Pathologist
- El Paso, TX
National Provider Identifier
1659400471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 14445
- Practice address
- 11150 Montwood Drive
BLDG a.
El Paso, TX 79936 - Phone
- (915) 594-0202
- Fax
- (915) 591-2116
- NPI assigned
- Mar 5, 2007
- 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 | 14445 | TX | Primary |
Addresses
Primary practice location
11150 Montwood Drive
BLDG a.
El Paso, TX 79936
Mailing address
11150 Montwood Drive
BLDG a.
El Paso, TX 79936
Phone (915) 594-0202
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004638502 | Medicaid | TX |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14445 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ukep Montwood Campus LLC | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Child & Adolescent Psychiatry Physician
- El Paso, TX
- NPI 1912110453
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351814400000",
"number": "1659400471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11150 MONTWOOD DRIVE",
"address_2": "BLDG A.",
"city": "EL PASO",
"state": "TX",
"postal_code": "79936",
"telephone_number": "915-594-0202",
"fax_number": "915-591-2116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11150 MONTWOOD DRIVE",
"address_2": "BLDG A.",
"city": "EL PASO",
"state": "TX",
"postal_code": "79936",
"telephone_number": "915-594-0202",
"fax_number": "915-591-2116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DIANE",
"name_prefix": "Ms.",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2012-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "14445",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004638502",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.