Active NPI
Mirjana Gomez
- Speech-Language Pathologist
- Whitefish Bay, WI
National Provider Identifier
1790233161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4331-154
- Practice address
- 722 E Henry Clay St
Apt 5
Whitefish Bay, WI 53217-5615 - Phone
- (310) 795-1633
- NPI assigned
- Sep 14, 2016
- 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 | 4331-154 | WI | Primary |
Addresses
Primary practice location
722 E Henry Clay St
Apt 5
Whitefish Bay, WI 53217-5615
Mailing address
722 E Henry Clay St
Apt 5
Whitefish Bay, WI 53217-5615
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 |
|---|---|---|---|
| 4331-154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1790233161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "722 E HENRY CLAY ST",
"address_2": "APT 5",
"city": "WHITEFISH BAY",
"state": "WI",
"postal_code": "532175615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "722 E HENRY CLAY ST",
"address_2": "APT 5",
"city": "WHITEFISH BAY",
"state": "WI",
"postal_code": "532175615",
"telephone_number": "310-795-1633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "MIRJANA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-14",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "4331-154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Whitefish Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.