Active NPI
Angela Jane Poulsen, SLP
- Speech-Language Pathologist
- Sussex, WI
National Provider Identifier
1407570658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2884
- Practice address
- W231N7946 Martin CT
Sussex, WI 53089-5700 - Phone
- (262) 408-9335
- NPI assigned
- Sep 30, 2022
- 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 | 2884 | WI | Primary |
Addresses
Primary practice location
W231N7946 Martin CT
Sussex, WI 53089-5700
Mailing address
W231N7946 Martin CT
Sussex, WI 53089-5700
Phone (262) 408-9335
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 |
|---|---|---|---|
| 2884 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664496000000",
"number": "1407570658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W231N7946 MARTIN CT",
"city": "SUSSEX",
"state": "WI",
"postal_code": "530895700",
"telephone_number": "262-408-9335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W231N7946 MARTIN CT",
"city": "SUSSEX",
"state": "WI",
"postal_code": "530895700",
"telephone_number": "262-408-9335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULSEN",
"first_name": "ANGELA",
"middle_name": "JANE",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-30",
"last_updated": "2022-09-30",
"certification_date": "2022-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "2884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sussex, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.