Active NPI
Sidrah Amhed Khan
- Speech-Language Pathologist
- Port Edwards, WI
National Provider Identifier
1376141473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5104-154
- Practice address
- 1351 Wisconsin River Dr
Port Edwards, WI 54469-1099 - Phone
- (715) 885-8333
- NPI assigned
- Oct 12, 2020
- Last updated
- Oct 12, 2020
- 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 | 5104-154 | WI | Primary |
Addresses
Primary practice location
1351 Wisconsin River Dr
Port Edwards, WI 54469-1099
Mailing address
1425 N 12TH Ave Apt 310
Wausau, WI 54401-2457
Phone (201) 281-9672
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 |
|---|---|---|---|
| 5104-154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602460800000",
"number": "1376141473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1425 N 12TH AVE APT 310",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544012457",
"telephone_number": "201-281-9672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1351 WISCONSIN RIVER DR",
"city": "PORT EDWARDS",
"state": "WI",
"postal_code": "544691099",
"telephone_number": "715-885-8333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "SIDRAH",
"middle_name": "AMHED",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-12",
"last_updated": "2020-10-12",
"certification_date": "2020-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "5104-154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Edwards, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.