Shannon Marie Mulder, MS-CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2023041204 Issued in MO

Practice address

13476 Hidden Creek CT
Grand Haven, MI 49417-8935

Phone

(616) 402-2187

NPI assigned

Oct 12, 2023

Last updated

Oct 12, 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

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  NPD

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

{
    "created_epoch": "1697068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1265213508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13476 HIDDEN CREEK CT",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494178935",
            "telephone_number": "616-402-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13476 HIDDEN CREEK CT",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494178935",
            "telephone_number": "616-402-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULDER",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "credential": "MS-CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-12",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2023041204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountford and Ruszkowski Family Dentistry PLLC (Mountford and Ruszkowski Family Dentistry)
• Christopher Michael Mountford, DDS
• Movement Chiropractic Center, PLLC
• Montana Joy Mueller, MSW
• Emile Mulder, PH.D.
• Myeyedr Optometry of Michigan, LLC (RX Optical)
• Dana Beth Nagelkirk, MSW
• Manpreet Nahal
• Keith A. Nalley, DDS, MS
• Nature and Nurtured LLC

• Speech-Language Pathologist in Grand Haven, MI
• Providers in Grand Haven, 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 Oct 12, 2023; 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.