Active NPI
Michelle Jennifer Granger, MS,CCC-SLP
- Speech-Language Pathologist
- Medford, WI
National Provider Identifier
1174673115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2901-154
- Practice address
- 103 S Gibson St
Medford, WI 54451 - Phone
- (715) 748-8112
- Fax
- (715) 748-8792
- NPI assigned
- Jan 11, 2007
- 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 | 2901-154 | WI | Primary |
Addresses
Primary practice location
103 S Gibson St
Medford, WI 54451
Mailing address
135 S Gibson St
Medford, WI 54451-1622
Phone (715) 748-8100
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901-154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184025600000",
"number": "1174673115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 S GIBSON ST",
"city": "MEDFORD",
"state": "WI",
"postal_code": "544511622",
"telephone_number": "715-748-8100",
"fax_number": "715-748-8199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 S GIBSON ST",
"city": "MEDFORD",
"state": "WI",
"postal_code": "54451",
"telephone_number": "715-748-8112",
"fax_number": "715-748-8792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANGER",
"first_name": "MICHELLE",
"middle_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "MS,CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "2901-154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.