Individual provider Active NPI

Dana Marie Entwistle, MS, CCC-SLP, CLC

  • Speech-Language Pathologist
  • Charlotte, NC
National Provider Identifier
1821895053
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
12432 Issued in NC
Practice address
1001 Blythe Blvd FL 5
Charlotte, NC 28203-5866
Phone
(704) 381-3313
NPI assigned
Feb 26, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 12432 NC Primary

Addresses

Primary practice location

1001 Blythe Blvd FL 5
Charlotte, NC 28203-5866

Mailing address

17427 Summers Walk Blvd
Davidson, NC 28036-8948
Phone (919) 771-6402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250416002545 NC Practitioner - Qualified Speech Language Pathologist 1355866997 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
12432NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Mar 3, 2025 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Mar 3, 2025 Accepting new patients

Locations

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1740528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1821895053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17427 SUMMERS WALK BLVD",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280368948",
            "telephone_number": "919-771-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 BLYTHE BLVD FL 5",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035866",
            "telephone_number": "704-381-3313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENTWISTLE",
        "first_name": "DANA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MS, CCC-SLP, CLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-26",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "12432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.