Active NPI
Michelle Lynn Wiersma, MS, CCC-SLP
- Speech-Language Pathologist
- Minnetonka, MN
National Provider Identifier
1871817429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 8402
- Practice address
- 11900 Wayzata Blvd Ste 132
Minnetonka, MN 55305-2018 - Phone
- (952) 236-6188
- NPI assigned
- Mar 24, 2010
- 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 | 8402 | MN | Primary |
Addresses
Primary practice location
11900 Wayzata Blvd Ste 132
Minnetonka, MN 55305-2018
Mailing address
4101 Parklawn Ave Apt 120
Edina, MN 55435-4660
Phone (651) 769-5672
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8402 | MN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269388800000",
"number": "1871817429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4101 PARKLAWN AVE APT 120",
"city": "EDINA",
"state": "MN",
"postal_code": "554354660",
"telephone_number": "651-769-5672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11900 WAYZATA BLVD STE 132",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553052018",
"telephone_number": "952-236-6188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIERSMA",
"first_name": "MICHELLE",
"middle_name": "LYNN",
"credential": "MS, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-24",
"last_updated": "2010-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "8402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.