Active NPI
Mary Wilson, MA, CCC-SLP
- Speech-Language Pathologist
- Mason, OH
National Provider Identifier
1700291432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP11576
- Practice address
- 4782 Carriage Dr
Mason, OH 45040-8708 - Phone
- (440) 759-1552
- NPI assigned
- Jun 20, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2014298 | OH | |
| Speech-Language Pathologist | 235Z00000X | SP11576 | OH | Primary |
Addresses
Primary practice location
4782 Carriage Dr
Mason, OH 45040-8708
Mailing address
4782 Carriage Dr
Mason, OH 45040-8708
Phone (440) 759-1552
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2187155 | Medicaid | OH |
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 |
|---|---|---|---|
| 2014298 | OH | MD | Speech-Language Pathologist |
| SP11576 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627516800000",
"number": "1700291432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4782 CARRIAGE DR",
"city": "MASON",
"state": "OH",
"postal_code": "450408708",
"telephone_number": "440-759-1552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4782 CARRIAGE DR",
"city": "MASON",
"state": "OH",
"postal_code": "450408708",
"telephone_number": "440-759-1552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MARY",
"credential": "MA, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-20",
"last_updated": "2021-07-29",
"certification_date": "2021-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "2014298",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "SP11576",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2187155",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mason, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.