Active NPI
Jordan Rae Ile, SLP
- Speech-Language Pathologist
- Wausau, WI
National Provider Identifier
1306414347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5261-154
- Practice address
- 520 N 28TH Ave
Wausau, WI 54401-4101 - Phone
- (715) 845-4900
- NPI assigned
- Jun 16, 2021
- 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 | 5261-154 | WI | Primary |
Addresses
Primary practice location
520 N 28TH Ave
Wausau, WI 54401-4101
Mailing address
2428 Frosty Pines LN
Kronenwetter, WI 54455-9276
Phone (608) 558-9246
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 |
|---|---|---|---|
| 5261-154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678233600000",
"number": "1306414347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2428 FROSTY PINES LN",
"city": "KRONENWETTER",
"state": "WI",
"postal_code": "544559276",
"telephone_number": "608-558-9246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 N 28TH AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014101",
"telephone_number": "715-845-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ILE",
"first_name": "JORDAN",
"middle_name": "RAE",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-16",
"last_updated": "2023-03-08",
"certification_date": "2023-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "5261-154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.