Individual provider Active NPI

Elizabeth T Wylde

  • Clinical Social Worker
  • Ypsilanti, MI
National Provider Identifier
1538752159
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801109058 Issued in MI
Practice address
13 N Washington St
Ypsilanti, MI 48197-2617
Phone
(734) 325-9531
NPI assigned
Feb 15, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 6801109058 MI Primary

Addresses

Primary practice location

13 N Washington St
Ypsilanti, MI 48197-2617

Mailing address

801 W Big Beaver Rd Ste 300
Troy, MI 48084-4725
Phone (734) 325-9531

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240213001164 MI Practitioner - Clinical Social Worker 7113360538 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

801 W Big Beaver Rd
Suite 300
Troy, MI 48084-4725
Phone (734) 787-2410

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Affirming Pathways LLC Clinical CurrentSince Jan 1, 2024 Accepting new patients

Locations

801 W Big Beaver Rd
Ste 300
Troy, MI 48084
Phone (248) 658-8424

Organizations & group practices 1

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": "1613347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1538752159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 W BIG BEAVER RD STE 300",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844725",
            "telephone_number": "734-325-9531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 N WASHINGTON ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481972617",
            "telephone_number": "734-325-9531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLDE",
        "first_name": "ELIZABETH",
        "middle_name": "T",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-15",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801109058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.