Active NPI
Pamela Polan, CCC-SLP
- Speech-Language Pathologist
- Hartland, MI
National Provider Identifier
1487029302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7101000843
- Practice address
- 12319 Highland Rd
Hartland, MI 48353-2946 - Phone
- (810) 991-1211
- NPI assigned
- Dec 3, 2015
- 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 | 7101000843 | MI | Primary |
Addresses
Primary practice location
12319 Highland Rd
Hartland, MI 48353-2946
Mailing address
12010 Caldwaller Rd
Fenton, MI 48430-8418
Phone (810) 629-8876
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7101000843 | MI | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivyrehab Michigan, LLC | Speech-Language Pathologist | Past | Accepting new patients |
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.
-
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Fenton, MI
- NPI 1104337120
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449100800000",
"number": "1487029302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12010 CALDWALLER RD",
"city": "FENTON",
"state": "MI",
"postal_code": "484308418",
"telephone_number": "810-629-8876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12319 HIGHLAND RD",
"city": "HARTLAND",
"state": "MI",
"postal_code": "483532946",
"telephone_number": "810-991-1211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLAN",
"first_name": "PAMELA",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-12-03",
"last_updated": "2015-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MI",
"license": "7101000843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.