Individual provider Active NPI

Wendy Harrison, M.ED.,CCC-SLP

  • Speech-Language Pathologist
  • Lawrenceville, GA
National Provider Identifier
1669548897
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP003291 Issued in GA
Practice address
318 W Pike St
Suite 104
Lawrenceville, GA 30045-3234
Phone
(678) 377-2833
Fax
(678) 377-2882
NPI assigned
Nov 28, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP003291 GA Primary

Addresses

Primary practice location

318 W Pike St
Suite 104
Lawrenceville, GA 30045-3234

Mailing address

318 W Pike St
Suite 104
Lawrenceville, GA 30045-3234
Phone (678) 377-2833

Other identifiers 2

IdentifierTypeStateIssuer
52198760-001OtherGABCBS PROVIDER ID
10049378MedicaidGA

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 Education

State licenses

LicenseStateTypeSpecialty
SLP003291GAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1669548897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 W PIKE ST",
            "address_2": "SUITE 104",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453234",
            "telephone_number": "678-377-2833",
            "fax_number": "678-377-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 W PIKE ST",
            "address_2": "SUITE 104",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453234",
            "telephone_number": "678-377-2833",
            "fax_number": "678-377-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRISON",
        "first_name": "WENDY",
        "credential": "M.ED.,CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP003291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "52198760-001",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10049378",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.