Catherine Rae Woidtke, M.S., CCC-SLP

Key facts

NPI

1124449418

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

445495 (MN)

Practice address

7418 Long Point Dr NW
Williams, MN 56686-4501

Phone

(218) 783-7366

NPI assigned

Jan 3, 2014

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 3, 2014.

{
    "created_epoch": "1388707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388707200000",
    "number": "1124449418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7418 LONG POINT DR NW",
            "city": "WILLIAMS",
            "state": "MN",
            "postal_code": "566864501",
            "telephone_number": "218-783-7366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7418 LONG POINT DR NW",
            "city": "WILLIAMS",
            "state": "MN",
            "postal_code": "566864501",
            "telephone_number": "218-783-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOIDTKE",
        "first_name": "CATHERINE",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-03",
        "last_updated": "2014-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "445495",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "000029956",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}