Individual provider Active NPI

Michelle Leigh Wanders

  • Speech-Language Pathologist
  • Surprise, AZ
National Provider Identifier
1508053984
Registry record updated Sep 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
TSLP5656 Issued in AZ
Practice address
15802 N Parkview PL
Surprise, AZ 85374-7466
Phone
(623) 876-7000
NPI assigned
Sep 28, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X TSLP5656 AZ Primary

Addresses

Primary practice location

15802 N Parkview PL
Surprise, AZ 85374-7466

Mailing address

12309 N 127TH LN
El Mirage, AZ 85335-2204

Other identifiers 1

IdentifierTypeStateIssuer
173181OtherAZAHCCCS PROVIDER ID

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

LicenseStateTypeSpecialty
TSLP5656AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dysart Unified School District Past Accepting new patients
Dysart Unified School District Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190937600000",
    "number": "1508053984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12309 N 127TH LN",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853352204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15802 N PARKVIEW PL",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853747466",
            "telephone_number": "623-876-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANDERS",
        "first_name": "MICHELLE",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-28",
        "last_updated": "2007-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "TSLP5656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER ID",
            "identifier": "173181",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.

Verify at the official NPI Registry.