Vivian Dyanne Wallace, M.ED.

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP000631 Issued in GA

Practice address

735 Longleaf Blvd
Suite a
Lawrenceville, GA 30045-8460

Phone

(770) 995-2378

Fax

(678) 377-9272

NPI assigned

Nov 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

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.

• Bailey Speech and Language Services

  • Speech-Language Pathologist
  • Lawrenceville, GA
  • NPI 1457427338
  NPD (past)
• Bailey Speech and Language Services

  • Speech-Language Pathologist
  • Lawrenceville, GA
  • NPI 1972596898
  NPD (past)

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821163023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 LONGLEAF BLVD",
            "address_2": "SUITE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300458460",
            "telephone_number": "770-995-2378",
            "fax_number": "678-377-9272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 LONGLEAF BLVD",
            "address_2": "SUITE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300458460",
            "telephone_number": "770-995-2378",
            "fax_number": "678-377-9272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "VIVIAN",
        "middle_name": "DYANNE",
        "name_prefix": "Ms.",
        "credential": "M.ED.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP000631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00584427B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natarsha Monyanmah Wall, NP
• Wallace F. Martin, M.D.
• Candice E Wallace, MD
• Deborah A Wallace, CRNA
• Julia Danielle Wallace, OTR/L
• Lisa Nicole Walls, M.ED.
• Megan Walton, LPN
• Phillip G Walton, M.D.
• James Wan, MD
• Eileen Wang, MD

• Speech-Language Pathologist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.