Stephanie Wise, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

110366 Issued in TX

Practice address

1202 Lakeway Dr Ste 6a
Lakeway, TX 78734-4481

Phone

(512) 261-3584

NPI assigned

Dec 4, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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.

• Mindy L Granberry PLLC

  • Multi-Specialty Clinic/Center
  • Spicewood, TX
  • NPI 1851632509

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522627200000",
    "number": "1992170724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LAKEWAY DR STE 6A",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787344481",
            "telephone_number": "512-261-3584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 LAKEWAY DR STE 6A",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787344481",
            "telephone_number": "512-261-3584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "STEPHANIE",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-04",
        "last_updated": "2018-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "110366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Brooke Whitman, PT, DPT
• Mark Wigginton, MS,LPC
• Tristan Leigh Wild, O.D.
• Kim Williams, LCSW
• Paige Wimbush, RBT
• Linda Wisner, LPC
• Brandi Nichole Wolf, FNP-C
• Mary Wong, M.D.
• Gregg L Wood, M.D.
• Brooke Elizabeth Woolever, M.A., CCC-SLP

• Speech-Language Pathologist in Lakeway, TX
• Providers in Lakeway, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2018; 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.