Individual provider Active NPI

Carolyn Miller

  • Speech-Language Pathologist
  • Grand Rapids, MI
National Provider Identifier
1508775560
Registry record updated Sep 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7101010159 Issued in MI
Practice address
2922 Fuller Ave NE Ste 107
Grand Rapids, MI 49505-3459
Phone
(616) 570-0925
NPI assigned
Sep 4, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 7101010159 MI Primary

Addresses

Primary practice location

2922 Fuller Ave NE Ste 107
Grand Rapids, MI 49505-3459

Mailing address

1924 RW Berends Dr SW Apt 6
Wyoming, MI 49519-6522
Phone (616) 570-0925

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1788480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788480000000",
    "number": "1508775560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1924 RW BERENDS DR SW APT 6",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495196522",
            "telephone_number": "616-570-0925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2922 FULLER AVE NE STE 107",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495053459",
            "telephone_number": "616-570-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "CAROLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-09-04",
        "last_updated": "2026-09-04",
        "certification_date": "2026-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101010159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.