NPIMap

Organization Active NPI

Duncan Lake Speech Therapy, LLC

  • Speech-Language Pathologist
  • Kentwood, MI
National Provider Identifier
1376195925
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
DUNCAN LAKE SPEECH THERAPY, LLC
Practice address
2450 44TH St SE Ste 201
Kentwood, MI 49512-9081
Phone
(616) 528-0870
Fax
(616) 591-5684
NPI assigned
Jul 14, 2019
Last updated
May 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Tamiko E TeshimaNPI 1689238727
Title
Owner and SLP
Phone
(616) 528-0870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Speech-Language Pathologist 235Z00000X Primary

Addresses

Primary practice location

2450 44TH St SE Ste 201
Kentwood, MI 49512-9081

Mailing address

2450 44TH St SE Ste 201
Kentwood, MI 49512-9081
Phone (616) 528-0870

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201217002575 MI Part B Supplier - Clinic/Group Practice 6305258203 Receives reassigned benefits from 21 practitioners
Practice locations: Kentwood, MI

National Provider Directory

National Provider Directory
Tax ID family
Duncan Lake SPCH Thrpy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3737 Lake Eastbrook Blvd SE
Ste 218
Grand Rapids, MI 49546
Phone (616) 528-0870

2180 44th St SE
Ste 103
Kentwood, MI 49508
Phone (616) 528-0870

2450 44th St SE
Ste 201
Kentwood, MI 49512
Phone (616) 528-0870

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1563062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1376195925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 44TH ST SE STE 201",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495129081",
            "telephone_number": "616-528-0870",
            "fax_number": "616-591-5684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 44TH ST SE STE 201",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495129081",
            "telephone_number": "616-528-0870",
            "fax_number": "616-591-5684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUNCAN LAKE SPEECH THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-14",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "TESHIMA",
        "authorized_official_first_name": "TAMIKO",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER AND SLP",
        "authorized_official_telephone_number": "616-528-0870"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.