Active NPI
Toni Willis, MA-CCC-SLP
- Speech-Language Pathologist
- Springfield, MI
National Provider Identifier
1013507367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 777 Goguac St W Ste B2
Springfield, MI 49015-2097 - Phone
- (269) 223-7786
- NPI assigned
- Jan 21, 2021
- Last updated
- Jan 21, 2021
- Sex
- Female
- 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 | Primary |
Addresses
Primary practice location
777 Goguac St W Ste B2
Springfield, MI 49015-2097
Mailing address
777 Goguac St W Ste B2
Springfield, MI 49015-2097
Phone (269) 223-7786
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000000000 | Medicaid | MI |
Other names 1
- Miss Toni Medure
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | SPRINGFIELD | Functional Kids Therapy Center LLC | |
| CONNECT URL | SPRINGFIELD | Direct | FUNctional Kids Therapy Center LLC |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611187200000",
"number": "1013507367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 GOGUAC ST W STE B2",
"city": "SPRINGFIELD",
"state": "MI",
"postal_code": "490152097",
"telephone_number": "269-223-7786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 GOGUAC ST W STE B2",
"city": "SPRINGFIELD",
"state": "MI",
"postal_code": "490152097",
"telephone_number": "269-223-7786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "TONI",
"name_prefix": "Mrs.",
"credential": "MA-CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-21",
"last_updated": "2021-01-21",
"certification_date": "2021-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000000000",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "SPRINGFIELD",
"affiliation": "Y",
"affiliationName": "Functional Kids Therapy Center LLC",
"address_1": "777 Goguac St W Ste B2",
"city": "Springfield",
"state": "MI",
"country_code": "US",
"postal_code": "490152097",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "SPRINGFIELD",
"affiliation": "Y",
"affiliationName": "FUNctional Kids Therapy Center LLC",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "777 Goguac St W Ste B2",
"city": "Springfield",
"state": "MI",
"country_code": "US",
"postal_code": "490152097",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "TONI",
"last_name": "MEDURE",
"prefix": "MISS",
"credential": "MA-CCC-SLP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Springfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.