Active NPI
Mary Denise Minyard
- Speech-Language Pathologist
- Lago Vista, TX
National Provider Identifier
1861146714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 19270
- Practice address
- 20209 Buchanan CV
Lago Vista, TX 78645-7140 - Phone
- (432) 413-6334
- NPI assigned
- Feb 9, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 19270 | TX | Primary |
Addresses
Primary practice location
20209 Buchanan CV
Lago Vista, TX 78645-7140
Mailing address
20209 Buchanan CV
Lago Vista, TX 78645-7140
Phone (432) 413-6334
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 |
|---|---|---|---|
| 19270 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647820800000",
"number": "1861146714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20209 BUCHANAN CV",
"city": "LAGO VISTA",
"state": "TX",
"postal_code": "786457140",
"telephone_number": "432-413-6334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20209 BUCHANAN CV",
"city": "LAGO VISTA",
"state": "TX",
"postal_code": "786457140",
"telephone_number": "432-413-6334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINYARD",
"first_name": "MARY",
"middle_name": "DENISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-09",
"last_updated": "2022-03-21",
"certification_date": "2022-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "19270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lago Vista, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.