Active NPI
Markie Rydholm Mickey, M.A. CCC-SLP
- Speech-Language Pathologist
- Greeley, CO
National Provider Identifier
1689200396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP.0003887
- Practice address
- 5699 W 20TH St
Greeley, CO 80634-2915 - Phone
- (970) 451-1234
- NPI assigned
- Mar 14, 2020
- 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 | SLP.0003887 | CO | Primary |
Addresses
Primary practice location
5699 W 20TH St
Greeley, CO 80634-2915
Mailing address
12295 Crabapple St
Broomfield, CO 80020-7975
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 |
|---|---|---|---|
| SLP.0003887 | CO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668729600000",
"number": "1689200396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12295 CRABAPPLE ST",
"city": "BROOMFIELD",
"state": "CO",
"postal_code": "800207975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5699 W 20TH ST",
"city": "GREELEY",
"state": "CO",
"postal_code": "806342915",
"telephone_number": "970-451-1234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKEY",
"first_name": "MARKIE",
"middle_name": "RYDHOLM",
"credential": "M.A. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-14",
"last_updated": "2022-11-18",
"certification_date": "2022-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CO",
"license": "SLP.0003887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greeley, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.