Active NPI
Wilson Bruce Martin, CF/SLP
- Speech-Language Pathologist
- Lewis, CO
National Provider Identifier
1013152495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- PENDING
- Practice address
- 18740 County Road V
Lewis, CO 81327-9610 - Phone
- (970) 882-3186
- NPI assigned
- Dec 12, 2008
- Last updated
- Dec 12, 2008
- Sex
- Male
- 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 | PENDING | NM | Primary |
Addresses
Primary practice location
18740 County Road V
Lewis, CO 81327-9610
Mailing address
18740 County Road V
Lewis, CO 81327-9610
Phone (970) 882-3186
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 |
|---|---|---|---|
| PENDING | NM | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229040000000",
"number": "1013152495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18740 COUNTY ROAD V",
"city": "LEWIS",
"state": "CO",
"postal_code": "813279610",
"telephone_number": "970-882-3186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18740 COUNTY ROAD V",
"city": "LEWIS",
"state": "CO",
"postal_code": "813279610",
"telephone_number": "970-882-3186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "WILSON",
"middle_name": "BRUCE",
"credential": "CF/SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-12",
"last_updated": "2008-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "PENDING",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewis, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.