NPIMap

Organization Active NPI

Upstate Pediatric Speech Therapy Services

  • Speech-Language Pathologist
  • Mauldin, SC
National Provider Identifier
1952693723
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
UPSTATE PEDIATRIC SPEECH THERAPY SERVICES
Doing business as
Upstate Pediatric Speech Therapy Services
Practice address
310 New Neely Ferry Rd
Mauldin, SC 29662-2617
Phone
(864) 438-0990
Fax
(864) 478-8383
NPI assigned
May 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Dr. Shannon L . Williamson, PH.D.NPI 1275624181
Title
SLP/President/Owner
Phone
(864) 438-0990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

310 New Neely Ferry Rd
Mauldin, SC 29662-2617

Mailing address

310 New Neely Ferry Rd
Mauldin, SC 29662-2617
Phone (864) 438-0990

Other names 1

  • Upstate Pediatric Speech Therapy Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231122000646 SC Part B Supplier - Clinic/Group Practice 8729436241 Receives reassigned benefits from 1 practitioner
Practice locations: Mauldin, SC

National Provider Directory

National Provider Directory

Locations

310 New Neely Ferry Rd
Mauldin, SC 29662
Phone (864) 438-0990

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1952693723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 NEW NEELY FERRY RD",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622617",
            "telephone_number": "864-438-0990",
            "fax_number": "864-478-8383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 NEW NEELY FERRY RD",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622617",
            "telephone_number": "864-438-0990",
            "fax_number": "864-478-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE PEDIATRIC SPEECH THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "L .",
        "authorized_official_title_or_position": "SLP/PRESIDENT/OWNER",
        "authorized_official_telephone_number": "864-438-0990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Upstate Pediatric Speech Therapy Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Upstate Pediatric Speech Therapy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mauldin, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.