Active NPI
Michelle Wilson, SLP
- Speech-Language Pathologist
- Saint Marys, OH
National Provider Identifier
1194957662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP4994
- Practice address
- 476 Fortman Dr
Saint Marys, OH 45885-1870 - Phone
- (419) 300-8400
- Fax
- (419) 300-8401
- NPI assigned
- Aug 18, 2009
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP4994 | OH | Primary |
Addresses
Primary practice location
476 Fortman Dr
Saint Marys, OH 45885-1870
Mailing address
1009 Magnolia St
Saint Marys, OH 45885-1410
Phone (419) 394-1489
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 |
|---|---|---|---|
| SP4994 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1250553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250553600000",
"number": "1194957662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1009 MAGNOLIA ST",
"city": "SAINT MARYS",
"state": "OH",
"postal_code": "458851410",
"telephone_number": "419-394-1489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "476 FORTMAN DR",
"city": "SAINT MARYS",
"state": "OH",
"postal_code": "458851870",
"telephone_number": "419-300-8400",
"fax_number": "419-300-8401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MICHELLE",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-18",
"last_updated": "2009-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "SP4994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Marys, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.