Kelly Sanderson, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7101001457 Issued in MI

Practice address

1691 E US 23 Ste 4
East Tawas, MI 48730-9337

Phone

(989) 479-7550

NPI assigned

Mar 23, 2007

Last updated

Jul 25, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1184741290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3781 S CRUZEN RD",
            "city": "MIKADO",
            "state": "MI",
            "postal_code": "487458761",
            "telephone_number": "989-335-3942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1691 E US 23 STE 4",
            "city": "EAST TAWAS",
            "state": "MI",
            "postal_code": "487309337",
            "telephone_number": "989-479-7550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3781 S Cruzen Rd",
            "address_purpose": "LOCATION",
            "city": "Mikado",
            "state": "MI",
            "postal_code": "487458761",
            "country_code": "US",
            "telephone_number": "989-335-3942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "KELLY",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101001457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100462120",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in East Tawas, MI
• Providers in East Tawas, 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 Jul 25, 2023; 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.