Cynthia Waller, ED.S, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

114233 Issued in TX

Practice address

4205 Old Florence Road
Killeen, TX 76542

Phone

(254) 383-0706

NPI assigned

Apr 11, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Protherapy Solutions

  • Speech-Language Pathologist
  • Killeen, TX
  • NPI 1407473994
  NPD Authorized official

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

{
    "created_epoch": "1523404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523404800000",
    "number": "1740787209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5309 BUCKAROO PL",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765424074",
            "telephone_number": "404-695-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 OLD FLORENCE ROAD",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "76542",
            "telephone_number": "254-383-0706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "CYNTHIA",
        "credential": "ED.S, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-11",
        "last_updated": "2018-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "114233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyesha Walker
• Chazia Wall-Miles, LPC
• Wallace Speech Therapy
• James Wallace, HIS
• Nicole Broadway Wallace, LPCC
• Cheyenne Walling
• Mark Edward Walls Jr., LCDC
• Walnut Grove Community Services
• Walnut Grove Community Services, Inc.
• Daranisha Trichelle Wanamaker

• Speech-Language Pathologist in Killeen, TX
• Providers in Killeen, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; 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.