Active NPI
Candace Jean Cackowski
- Speech-Language Pathologist
- Ann Arbor, MI
National Provider Identifier
1770196792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7151013311
- Practice address
- 3200 W Liberty Rd Ste F
Ann Arbor, MI 48103-9180 - Phone
- (734) 369-6002
- NPI assigned
- Aug 28, 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 | 7151013311 | MI | Primary |
Addresses
Primary practice location
3200 W Liberty Rd Ste F
Ann Arbor, MI 48103-9180
Mailing address
3200 W Liberty Rd Ste F
Ann Arbor, MI 48103-9180
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7151013311 | Other | MI | STATE OF MICHIGAN - DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 7151013311 | MI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598572800000",
"number": "1770196792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 W LIBERTY RD STE F",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481039180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 W LIBERTY RD STE F",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481039180",
"telephone_number": "734-369-6002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CACKOWSKI",
"first_name": "CANDACE",
"middle_name": "JEAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-28",
"last_updated": "2020-08-28",
"certification_date": "2020-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MI",
"license": "7151013311",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MICHIGAN - DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS",
"identifier": "7151013311",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.