Shannon Broadwell

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

2915 Moraine Dr
Brighton, MI 48114-9218

Phone

(989) 948-0900

NPI assigned

Jul 17, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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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  • NPI 1104337120

  Speech-Language Pathologist

  Medicare reassignment NPD

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

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1497278956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5333 MCAULEY DR RM 2017",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971096",
            "telephone_number": "734-434-3200",
            "fax_number": "734-879-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 MORAINE DR",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481149218",
            "telephone_number": "989-948-0900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5333 McAuley Dr Rm 2017",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481971096",
            "country_code": "US",
            "telephone_number": "734-434-3200",
            "fax_number": "734-879-0550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROADWELL",
        "first_name": "SHANNON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-17",
        "last_updated": "2022-07-21",
        "certification_date": "2022-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brighton Vision Center, PC
• Michelle Brinsden
• Michael Robert Britt, DDS MS
• Abigail Rose Britton
• Rebecca Britton, LLMSW
• Sandra A. Bronsberg, LMSW
• Sophie Elena Brookes
• Michael Fulton Brooks, DO
• Rebecca Broome, LMSW
• Denise Brower, RPH

• Speech-Language Pathologist in Brighton, MI
• Providers in Brighton, 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 Jul 21, 2022; 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.