Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1114020369 Individual Practitioner Female Practitioner

Mary Louise Wallace , MA, CCC-SLP

Speech-Language Pathologist • Boulder, CO

Professional Overview & Biography Verified Profile Summary

Mary Wallace, MA, CCC-SLP is a registered healthcare professional specializing in Speech-Language Pathologist in Boulder, CO. Practice services are available at 6672 GUNPARK DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

6672 Gunpark Dr
Suite 101 C

Boulder, CO 803013387

Telephone 3035309191
Associated Practice Facility / Clinic
🏢 Ascend Child Development Facility NPI 1750784633

Specialty Benchmarks & Practice Insights

Comparative analytics for Speech-Language Pathologist in Boulder, CO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 23.3 Yrs
State Avg: 10.8 Yrs
Regional Practice Density
167 Specialists

Practicing in Boulder, CO (4289 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

State License CO 00198044

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
07198047 (CO)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Travis Althouse

Speech-Language Pathologist

NPI 1073379855
Elizabeth Gangware , MA CCC-SLP

Speech-Language Pathologist

NPI 1376417550

MACCCSLP

Elizabeth Smith , MA, CCC-SLP

Speech-Language Pathologist

NPI 1922030691

Master of Arts, Speech-Language Pathologist (Certificate of Clinical Competence)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 6672 GUNPARK DR, SUITE 101 C, BOULDER, CO 803013387 (Tel: 3035309191)

📍
Updated Business Mailing Address July 09, 2007

Registered at 6672 GUNPARK DR, SUITE 101 C, BOULDER, CO 803013387 (Tel: 3035309191)

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as MARY WALLACE, MA, CCC-SLP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Speech-Language Pathologist (License #00198044 in CO)

🟢
Initial NPI Registration & Enumeration September 06, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114020369
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 06, 2006
Last Update: July 09, 2007
Sole Proprietor: Yes

Mailing Address

6672 Gunpark Dr, Suite 101 C

Boulder, CO 803013387

Phone: 3035309191

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.