Active NPI
Michelle Anne Hulstrom, CCC-SLP
- Speech-Language Pathologist
- Lodi, CA
National Provider Identifier
1376849414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12799
- Practice address
- 2826 Cumbria Way
Lodi, CA 95242-9668 - Phone
- (209) 609-5179
- Fax
- (209) 263-7006
- NPI assigned
- Feb 8, 2011
- Sex
- Female
- 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 | 12799 | CA | Primary |
Addresses
Primary practice location
2826 Cumbria Way
Lodi, CA 95242-9668
Mailing address
2826 Cumbria Way
Lodi, CA 95242-9668
Phone (209) 609-5179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297123200000",
"number": "1376849414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2826 CUMBRIA WAY",
"city": "LODI",
"state": "CA",
"postal_code": "952429668",
"telephone_number": "209-609-5179",
"fax_number": "209-263-7006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2826 CUMBRIA WAY",
"city": "LODI",
"state": "CA",
"postal_code": "952429668",
"telephone_number": "209-609-5179",
"fax_number": "209-263-7006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HULSTROM",
"first_name": "MICHELLE",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-08",
"last_updated": "2011-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "12799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2011; 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.