Derek Michael Willging

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

242005649 Issued in IL

Practice address

11971 Wagon Wheel Rd
Rockton, IL 61072-3322

Phone

(815) 624-2615

NPI assigned

Oct 17, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Winnebago Co SP Ed Coop

  • Local Education Agency (LEA)
  • Rockton, IL
  • NPI 1730381294
  NPD

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1699318022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12076 TRESEMER RD",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610738925",
            "telephone_number": "815-601-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11971 WAGON WHEEL RD",
            "city": "ROCKTON",
            "state": "IL",
            "postal_code": "610723322",
            "telephone_number": "815-624-2615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLGING",
        "first_name": "DEREK",
        "middle_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-17",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "4965-154",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242005649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shari Tucker, LCPC
• Stephanie Unger, RN
• Joshua Vos
• Wal-Mart Stores, Inc Dba Wal-Mart
• Kristyn Diane Ward Powell, RDN, LDN
• Winnebago Co SP Ed Coop
• Jessie Leigh Zambrovitz

• All providers in Rockton, IL
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; 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.