Active NPI
Patricia Lorraine Willis, SPEECH LANGUAGE PATH
- Speech-Language Pathologist
- Waukesha, WI
National Provider Identifier
1851564660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 435154
- Practice address
- 1108 Grant St
Waukesha, WI 53186-6321 - Phone
- (262) 544-5044
- Fax
- (262) 544-5193
- NPI assigned
- Apr 12, 2008
- 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 | 435154 | WI | Primary |
Addresses
Primary practice location
1108 Grant St
Waukesha, WI 53186-6321
Mailing address
1108 Grant St
Waukesha, WI 53186-6321
Phone (262) 544-5044
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42686100 | Medicaid | WI |
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 |
|---|---|---|---|
| 435154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207958400000",
"number": "1851564660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1108 GRANT ST",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531866321",
"telephone_number": "262-544-5044",
"fax_number": "262-544-5193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1108 GRANT ST",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531866321",
"telephone_number": "262-544-5044",
"fax_number": "262-544-5193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "PATRICIA",
"middle_name": "LORRAINE",
"credential": "SPEECH LANGUAGE PATH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-12",
"last_updated": "2008-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "435154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42686100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waukesha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.