Kacy Wickerson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12381 Issued in NC

Practice address

11112 Scrimshaw LN
Charlotte, NC 28215-8304

Phone

(704) 258-7031

NPI assigned

Mar 22, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Kacy Brown Former name

Electronic endpoints 1

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.

• Teach Speech PLLC

  • Speech-Language Pathologist
  • Concord, NC
  • NPI 1265019699
  NPD Authorized official

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1831620855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11112 SCRIMSHAW LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158304",
            "telephone_number": "704-258-7031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11112 SCRIMSHAW LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158304",
            "telephone_number": "704-258-7031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11112 Scrimshaw Ln",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282158304",
            "country_code": "US",
            "telephone_number": "704-258-7031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKERSON",
        "first_name": "KACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-22",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP011439",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "6006",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "12381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "learn@teachspeechservices.com",
            "affiliation": "N",
            "endpointDescription": "encrypted email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11112 Scrimshaw Ln",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282158304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KACY",
            "last_name": "BROWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Joseph Wichnoski, O.D.
• Kathryn Weaver Wick, LMFT
• Stephanie Seymore Wick, MSOT
• Cara Wicker, MSN, APRN, FNP-C
• Rebeccah Shierson Wickerham, MD
• Kenneth James Wickey, PA
• Bethany Jonina Wickham
• Ashley Case Wickline
• Wickshire Steele Creek Opco, LLC
• Jeffrey S. Widelitz, MD

• Speech-Language Pathologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; 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.