Kandyce Ivory Wilson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

1692 Lakeview Ave
Rocky River, OH 44116-2443

Phone

(216) 760-3563

NPI assigned

Jan 20, 2021

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

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

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611100800000",
    "number": "1902496342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1692 LAKEVIEW AVE",
            "city": "ROCKY RIVER",
            "state": "OH",
            "postal_code": "441162443",
            "telephone_number": "216-760-3563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1692 LAKEVIEW AVE",
            "city": "ROCKY RIVER",
            "state": "OH",
            "postal_code": "441162443",
            "telephone_number": "216-760-3563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KANDYCE",
        "middle_name": "IVORY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abbey Lynn Wilcox-Samide, PCC-S
• William L Eick, D.D.S., Inc.
• Alexis Williams, LPCC, CRC, NCC
• Belinda F Williams
• Avril Michele Willoughby, CPRS
• Allison Elton Withers, MD
• Amy Witzigreuter
• Sharon Ann Wiza, MSW
• Women'S Welsh Clubs of America
• William David Wright, LPCC

• Peer Specialist in Rocky River, OH
• Providers in Rocky River, OH by specialty
• Peer Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.