Active NPI
Mary Lou McCormick, M.S. 2917-154 CCC
- Speech-Language Pathologist
- Madison, WI
National Provider Identifier
1639386139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2917 - 154
- Practice address
- 4005 Tokay Blvd
Madison, WI 53711-1677 - Phone
- (608) 238-7458
- Fax
- (608) 527-4392
- NPI assigned
- May 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 | 2917 - 154 | WI | Primary |
Addresses
Primary practice location
4005 Tokay Blvd
Madison, WI 53711-1677
Mailing address
4005 Tokay Blvd
Madison, WI 53711-1677
Phone (608) 238-7458
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2917 -154 | Other | WI | WISCONSIN STATE LICENSE |
| 01120904 | Other | WI | AMERICAN SPEECH LANGUAGE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2917 - 154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639386139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 TOKAY BLVD",
"city": "MADISON",
"state": "WI",
"postal_code": "537111677",
"telephone_number": "608-238-7458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 TOKAY BLVD",
"city": "MADISON",
"state": "WI",
"postal_code": "537111677",
"telephone_number": "608-238-7458",
"fax_number": "608-527-4392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "MARY",
"middle_name": "LOU",
"name_prefix": "Ms.",
"credential": "M.S. 2917-154 CCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "2917 - 154",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WISCONSIN STATE LICENSE",
"identifier": "2917 -154",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAN SPEECH LANGUAGE",
"identifier": "01120904",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.