Northern Pediatric Therapy PLLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

NORTHERN PEDIATRIC THERAPY PLLC

Practice address

19080 Ridge View LN
Lake Ann, MI 49650-9411

Phone

(616) 706-2916

NPI assigned

Mar 5, 2024

Organization subpart

No

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

Authorized official

Name

Megan Downer, SLP

Title

Speech Language Pathology

Phone

(231) 577-9421

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashley Fetters, MS, CCC-SLP, CLC

  • Speech-Language Pathologist
  • Washington, DC
  • NPI 1740728815
  NPD

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1053178079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5817",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496965817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19080 RIDGE VIEW LN",
            "city": "LAKE ANN",
            "state": "MI",
            "postal_code": "496509411",
            "telephone_number": "616-706-2916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN PEDIATRIC THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "DOWNER",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGY",
        "authorized_official_telephone_number": "231-577-9421",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joanna Lauber, MACSW
• Cameron Mills, AT
• Lauren Ashley Nickerson, NP-C
• Mary Ann Niesen, PHARM.D.
• Northern Michigan Neurology, P.L.C.
• Northside Counseling Inc
• Township of Almira

• Speech-Language Pathologist in Lake Ann, MI
• Providers in Lake Ann, MI by specialty
• Speech-Language Pathologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.