Lisa Willson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

002257 Issued in IA

Practice address

3740 Utica Ridge Rd
Suite 4
Bettendorf, IA 52722-1657

Phone

(563) 326-1400

NPI assigned

Dec 17, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Lisa Clough Former name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optimal Rehabilitation and Wellness LLCGroup PAC ID 8820244221, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optimal Rehabilitation & Wellness, L.L.C.

  • Physical Therapist
  • Frankenmuth, MI
  • NPI 1720343288
  Medicare reassignment Care Compare group
• Ivyrehab Michigan, LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fenton, MI
  • NPI 1104337120

  Speech-Language Pathologist

  Medicare reassignment NPD
• Hamtramck Orthopedic Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Davison, MI
  • NPI 1124027966
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1387238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1225459316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3740 UTICA RIDGE RD",
            "address_2": "SUITE 4",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527221657",
            "telephone_number": "563-326-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3740 UTICA RIDGE RD",
            "address_2": "SUITE 4",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527221657",
            "telephone_number": "563-326-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLSON",
        "first_name": "LISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-17",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IA",
            "license": "002257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "CLOUGH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William Burke LTD
• Solunda Williams
• Taylor L Williams, DPT
• Justin James Willis, CADC
• Allyson Willits, RD, LDN
• Amber Wilson
• Katherine S Wilson, ARNP
• Wanda Wims, M.A., CCC-SLP/L
• Amy Margaret Wine, L.I.S.W.
• Rebecca Wingate

• Speech-Language Pathologist in Bettendorf, IA
• Providers in Bettendorf, IA by specialty
• Speech-Language Pathologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.