Active NPI
Wesley Shane Blackburn, CCC-SLP
- Speech-Language Pathologist
- Needham, MA
National Provider Identifier
1801376827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 76489
- Practice address
- 150 Lincoln St
Needham, MA 02492-2914 - Phone
- (781) 449-4040
- NPI assigned
- Aug 20, 2018
- Sex
- Male
- 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 | 76489 | MA | Primary |
Addresses
Primary practice location
150 Lincoln St
Needham, MA 02492-2914
Mailing address
2 Hancock Street
Apartment 322
Quincy, MA 15427
Phone (724) 288-8779
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 |
|---|---|---|---|
| 76489 | MA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534723200000",
"number": "1801376827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 HANCOCK STREET",
"address_2": "APARTMENT 322",
"city": "QUINCY",
"state": "MA",
"postal_code": "15427",
"telephone_number": "724-288-8779",
"fax_number": "724-288-8779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 LINCOLN ST",
"city": "NEEDHAM",
"state": "MA",
"postal_code": "024922914",
"telephone_number": "781-449-4040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "WESLEY",
"middle_name": "SHANE",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-20",
"last_updated": "2018-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MA",
"license": "76489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Needham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.