Active NPI
Amanda McGukin, SLP
- Speech-Language Pathologist
- Southlake, TX
National Provider Identifier
1932479011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 107234
- Practice address
- 515 Timber Lake Dr
Southlake, TX 76092-7206 - Phone
- (949) 468-9348
- NPI assigned
- Jan 6, 2012
- 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 | 107234 | TX | Primary |
Addresses
Primary practice location
515 Timber Lake Dr
Southlake, TX 76092-7206
Mailing address
515 Timber Lake Dr
Southlake, TX 76092-7206
Phone (949) 468-9348
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 287168301 | Medicaid | TX | |
| 81S586 | Other | TX | BCBS |
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 |
|---|---|---|---|
| 107234 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391472000000",
"number": "1932479011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 TIMBER LAKE DR",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760927206",
"telephone_number": "949-468-9348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 TIMBER LAKE DR",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760927206",
"telephone_number": "949-468-9348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCGUKIN",
"first_name": "AMANDA",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-01-06",
"last_updated": "2014-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "107234",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "287168301",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "81S586",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.