Active NPI
Mary Caroline Wallace, M.A.
- Speech-Language Pathologist
- Washington, DC
National Provider Identifier
1851541163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2202005615
- Practice address
- 5 5TH St SE
Washington, DC 20003-1119 - Phone
- (434) 242-2039
- NPI assigned
- Sep 23, 2008
- Sex
- Female
- 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 | 2202005615 | VA | Primary |
Addresses
Primary practice location
5 5TH St SE
Washington, DC 20003-1119
Mailing address
5 5TH St SE
Washington, DC 20003-1119
Phone (434) 242-2039
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2202005615 | VA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222128000000",
"number": "1851541163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 5TH ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200031119",
"telephone_number": "434-242-2039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 5TH ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200031119",
"telephone_number": "434-242-2039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MARY",
"middle_name": "CAROLINE",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-23",
"last_updated": "2008-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2202005615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.