Active NPI
Olivia Misiak
- Speech-Language Pathologist
- West Bloomfield, MI
National Provider Identifier
1235812017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7152000574
- Practice address
- 6900 Orchard Lake Rd Ste 114
West Bloomfield, MI 48322-3424 - Phone
- (248) 655-5975
- NPI assigned
- Aug 9, 2023
- 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 | 7152000574 | MI | Primary |
Addresses
Primary practice location
6900 Orchard Lake Rd Ste 114
West Bloomfield, MI 48322-3424
Mailing address
6900 Orchard Lake Rd Ste 114
West Bloomfield, MI 48322-3424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260605003311 | MI | Practitioner - Qualified Speech Language Pathologist | 6204307689 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
40 Park Island Dr
Lake Orion, MI 48362-2758
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7152000574 | MI | MD | Speech-Language Pathologist |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717804800000",
"number": "1235812017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6900 ORCHARD LAKE RD STE 114",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483223424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 ORCHARD LAKE RD STE 114",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483223424",
"telephone_number": "248-655-5975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISIAK",
"first_name": "OLIVIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-08-09",
"last_updated": "2024-06-08",
"certification_date": "2024-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MI",
"license": "7152000574",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2024; 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.