NPIMap

Individual provider Active NPI

Tanysha Gibbs Wilson, MA CCC-SLP L

  • Speech-Language Pathologist
  • Florence, SC
National Provider Identifier
1720249287
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2797 Issued in SC
Practice address
314 Hutchinson Ave
Florence, SC 29505
Phone
(843) 664-0372
NPI assigned
Jun 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2797 SC Primary
Speech-Language Pathologist 235Z00000X 09141511 MD

Addresses

Primary practice location

314 Hutchinson Ave
Florence, SC 29505

Mailing address

314 Hutchinson Ave
Florence, SC 29505
Phone (843) 664-0372

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

LicenseStateTypeSpecialty
09141511MDMDSpeech-Language Pathologist
2797SCMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213747200000",
    "number": "1720249287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 HUTCHINSON AVE",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "29505",
            "telephone_number": "843-664-0372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 HUTCHINSON AVE",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "29505",
            "telephone_number": "843-664-0372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TANYSHA",
        "middle_name": "GIBBS",
        "name_prefix": "Mrs.",
        "credential": "MA CCC-SLP L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-18",
        "last_updated": "2008-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "2797",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "09141511",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.