Active NPI
Susanne Wilm, BSW
- Pastoral Counselor
- Port Saint Lucie, FL
National Provider Identifier
1174490841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- License
- 171M000000X
- Practice address
- 518 SW Prima Vista Blvd
Port Saint Lucie, FL 34983-8734 - Phone
- (772) 873-8811
- Fax
- (772) 873-8800
- NPI assigned
- Oct 18, 2025
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | 171M000000X | FL | Primary |
Addresses
Primary practice location
518 SW Prima Vista Blvd
Port Saint Lucie, FL 34983-8734
Mailing address
518 SW Prima Vista Blvd
Port Saint Lucie, FL 34983-8734
Phone (772) 873-8811
Other names 1
- MD Allen
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 |
|---|---|---|---|
| 171M000000X | FL | MD | Pastoral Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1760745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1760745600000",
"number": "1174490841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "518 SW PRIMA VISTA BLVD",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349838734",
"telephone_number": "772-873-8811",
"fax_number": "772-873-8800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "518 SW PRIMA VISTA BLVD",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349838734",
"telephone_number": "772-873-8811",
"fax_number": "772-873-8800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILM",
"first_name": "SUSANNE",
"credential": "BSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-10-18",
"last_updated": "2025-10-18",
"certification_date": "2025-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Pastoral",
"state": "FL",
"license": "171M000000X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MD",
"last_name": "ALLEN",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Port Saint Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.