Active NPI
Kellie Anne Woehlke, MA, CCC-SLP
- Speech-Language Pathologist
- Plymouth, MI
National Provider Identifier
1104452697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7101000187
- Practice address
- 46200 Port St
Plymouth, MI 48170-6048 - Phone
- (734) 454-0866
- NPI assigned
- Mar 17, 2020
- 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 | 7101000187 | MI | Primary |
Addresses
Primary practice location
46200 Port St
Plymouth, MI 48170-6048
Mailing address
50190 Van Buren St
Canton, MI 48188-2884
Phone (734) 502-3544
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7101000187 | MI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584403200000",
"number": "1104452697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50190 VAN BUREN ST",
"city": "CANTON",
"state": "MI",
"postal_code": "481882884",
"telephone_number": "734-502-3544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46200 PORT ST",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481706048",
"telephone_number": "734-454-0866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOEHLKE",
"first_name": "KELLIE",
"middle_name": "ANNE",
"credential": "MA, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-17",
"last_updated": "2020-03-17",
"certification_date": "2020-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MI",
"license": "7101000187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.