Active NPI
Maret Elizabeth Wilson, M.A.
- Speech-Language Pathologist
- San Rafael, CA
National Provider Identifier
1437340833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- RPE 4742
- Practice address
- 30 N San Pedro Rd
Suite 265
San Rafael, CA 94903-4118 - Phone
- (415) 479-7880
- Fax
- (415) 479-7889
- NPI assigned
- Aug 9, 2007
- 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 | RPE 4742 | CA | Primary |
Addresses
Primary practice location
30 N San Pedro Rd
Suite 265
San Rafael, CA 94903-4118
Mailing address
30 N San Pedro Rd
Suite 265
San Rafael, CA 94903-4118
Phone (415) 479-7880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPE 4742 | Other | CA | TEMPORARY STATE LICENSE |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPE 4742 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186617600000",
"number": "1437340833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 N SAN PEDRO RD",
"address_2": "SUITE 265",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949034118",
"telephone_number": "415-479-7880",
"fax_number": "415-479-7889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 N SAN PEDRO RD",
"address_2": "SUITE 265",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949034118",
"telephone_number": "415-479-7880",
"fax_number": "415-479-7889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MARET",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-09",
"last_updated": "2007-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "RPE 4742",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEMPORARY STATE LICENSE",
"identifier": "RPE 4742",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.