Shae Nimmo, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7101004726 Issued in MI

Practice address

206 N Howard St
Fenton, MI 48430-2195

Phone

(810) 429-9545

NPI assigned

Dec 29, 2023

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

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.

• Spark Speech Therapy LLC

  • Speech-Language Pathologist
  • Fenton, MI
  • NPI 1801649256
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1703808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1487423588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N HOWARD ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302195",
            "telephone_number": "810-429-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N HOWARD ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302195",
            "telephone_number": "810-429-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIMMO",
        "first_name": "SHAE",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-29",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101004726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Marie Murray-Laursen, R.N.
• Janet Lee Myers, LLBSWK
• Kyleigh Naismith, DO
• Neel Enterprise LLC
• Nicholas Weiss, LMSW, Caadc, PLLC
• Northbank Counseling Services, P.C.
• Nurture Family Center PC
• Amanda Kate O'Connell, BCBA
• Barbara A O'Hara, RPH
• Michael Shawn O'Hara, P.T.

• Speech-Language Pathologist in Fenton, MI
• Providers in Fenton, 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 Dec 29, 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.