Active NPI
Traci Janelle Wildey
- Speech-Language Pathologist
- Farmington Hills, MI
National Provider Identifier
1821436536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.011521
- Practice address
- 27240 Haggerty Rd
Suite E15
Farmington Hills, MI 48331-5716 - Phone
- (866) 991-0900
- NPI assigned
- Jun 5, 2013
- 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 | 146.011521 | IL | Primary |
Addresses
Primary practice location
27240 Haggerty Rd
Suite E15
Farmington Hills, MI 48331-5716
Mailing address
1020 W Ardmore Ave
Apt. 304
Chicago, IL 60660-3700
Phone (866) 991-0900
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 |
|---|---|---|---|
| 146.011521 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370390400000",
"number": "1821436536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 W ARDMORE AVE",
"address_2": "APT. 304",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606603700",
"telephone_number": "866-991-0900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27240 HAGGERTY RD",
"address_2": "SUITE E15",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483315716",
"telephone_number": "866-991-0900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDEY",
"first_name": "TRACI",
"middle_name": "JANELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-05",
"last_updated": "2013-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.011521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmington Hills, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.