Carly Carolyn Nielsen, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4687154 Issued in WI

Practice address

1400 Bellinger St
Eau Claire, WI 54703-5222

Phone

(715) 838-5222

NPI assigned

Jun 26, 2018

Last updated

Sep 8, 2021By the provider in NPPES

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

• Miss Carly Carolyn Kjornes Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Empowerme Rehabilitation LLCGroup PAC ID 2769723162, 423 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Empowerme Rehabilitation, LLC

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1144954074

  Speech-Language Pathologist

  Medicare reassignment Care Compare group NPD
• Empowerme Rehabilitation, LLC

  • Multi-Specialty Clinic/Center
  • Williamsburg, VA
  • NPI 1881366730

  Speech-Language Pathologist

  NPD
• Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

  dba Mayo Clinic Health System-Barron

  • Critical Access Hospital
  • Barron, WI
  • NPI 1740239557
  NPD (past)

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1427543040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547021510",
            "telephone_number": "715-838-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BELLINGER ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547035222",
            "telephone_number": "715-838-5222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2321 Stout Rd",
            "address_purpose": "LOCATION",
            "city": "Menomonie",
            "state": "WI",
            "postal_code": "54751",
            "country_code": "US",
            "telephone_number": "715-235-9671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "CARLY",
        "middle_name": "CAROLYN",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-26",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "4687154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "KJORNES",
            "middle_name": "CAROLYN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joy G Ngobi, MD
• Thao H Nguyen, FNP-C
• Marisa Ann Nichols, PHARM.D.
• Mattie Lynne Nicholson, CSW
• Benjamin Isaac Niebaum, PHARMD
• Martha E Nieman, CNM
• Eric R Niendorf, MD
• Amy Lynn Nikolai, PA-C
• Melissa A Nissen, MD
• Allison Nitchey, COTA

• Speech-Language Pathologist in Eau Claire, WI
• Providers in Eau Claire, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; 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.