Judy M Wylie, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

002288 Issued in MO

Practice address

16917 Manchester Rd
Grover, MO 63040-1209

Phone

(314) 517-5410

Fax

(636) 458-0911

NPI assigned

Sep 22, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Wildwood Health & Wellness Center, P.C.

  • Chiropractor
  • Wildwood, MO
  • NPI 1649553132
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851490817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1426 EAGLE RIDGE RD",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630382418",
            "telephone_number": "636-394-6119",
            "fax_number": "636-458-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16917 MANCHESTER RD",
            "city": "GROVER",
            "state": "MO",
            "postal_code": "630401209",
            "telephone_number": "314-517-5410",
            "fax_number": "636-458-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLIE",
        "first_name": "JUDY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "002288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Pemberton, AGNP
• Karl Robert Peterson, APRN CNM
• Professional Healthcare Services, LLC
• Stephanie Smith, D.C.
• Andrew Warner, M.ED, PLPC

• Professional Counselor in Grover, MO
• Providers in Grover, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.