Individual provider Active NPI

Lisa D Waddell, AUD

  • Audiologist
  • Ypsilanti, MI
National Provider Identifier
1629421896
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
160100000X Issued in MI
Practice address
8096 Park LN
Ypsilanti, MI 48198-3615
Phone
(734) 489-9395
NPI assigned
Jul 22, 2016
Last updated
Dec 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 160100000X MI Primary

Addresses

Primary practice location

8096 Park LN
Ypsilanti, MI 48198-3615

Mailing address

8096 Park LN
Ypsilanti, MI 48198-3615
Phone (734) 489-9395

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
160100000XMIMDAudiologist

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

NPI Registry JSON

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

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1629421896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8096 PARK LN",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481983615",
            "telephone_number": "734-489-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8096 PARK LN",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481983615",
            "telephone_number": "734-489-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDELL",
        "first_name": "LISA",
        "middle_name": "D",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-22",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MI",
            "license": "160100000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.