Active NPI
Steven Wilson
- Speech-Language Pathologist
- Chicago, IL
National Provider Identifier
1114434479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242.004755
- Practice address
- 811 W Evergreen Ave Ste 404
Chicago, IL 60642-7113 - Phone
- (312) 242-1665
- NPI assigned
- Jan 8, 2018
- 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 | 242.004755 | IL | Primary |
Addresses
Primary practice location
811 W Evergreen Ave Ste 404
Chicago, IL 60642-7113
Mailing address
811 W Evergreen Ave Ste 404
Chicago, IL 60642-7113
Phone (312) 242-1665
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 |
|---|---|---|---|
| 242.004755 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1515369600000",
"number": "1114434479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "811 W EVERGREEN AVE STE 404",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606427113",
"telephone_number": "312-242-1665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 W EVERGREEN AVE STE 404",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606427113",
"telephone_number": "312-242-1665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "STEVEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-08",
"last_updated": "2018-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242.004755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.