Active NPI
Michael Wilburn, SLP
- Speech-Language Pathologist
- La Grange Park, IL
National Provider Identifier
1972892545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146000259
- Practice address
- 442 Malden Ave
La Grange Park, IL 60526-1710 - Phone
- (708) 703-1215
- NPI assigned
- Apr 4, 2011
- Sex
- Male
- 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 | 146000259 | IL | Primary |
Addresses
Primary practice location
442 Malden Ave
La Grange Park, IL 60526-1710
Mailing address
442 Malden Avenue
Lagrange Park, IL 60526
Phone (708) 703-1215
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146000259 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301875200000",
"number": "1972892545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "442 MALDEN AVENUE",
"city": "LAGRANGE PARK",
"state": "IL",
"postal_code": "60526",
"telephone_number": "708-703-1215"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "442 MALDEN AVE",
"city": "LA GRANGE PARK",
"state": "IL",
"postal_code": "605261710",
"telephone_number": "708-703-1215"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILBURN",
"first_name": "MICHAEL",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-04-04",
"last_updated": "2011-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146000259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Grange Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.