Shannon Lorraine Clark

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7101006594 Issued in MI

Practice address

350 N Center St
Lowell, MI 49331-1212

Phone

(616) 897-8473

NPI assigned

Sep 21, 2016

Last updated

Jun 25, 2024By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1679021448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5333 MAPLE HILL AVE SE",
            "city": "ADA",
            "state": "MI",
            "postal_code": "493017717",
            "telephone_number": "616-828-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N CENTER ST",
            "city": "LOWELL",
            "state": "MI",
            "postal_code": "493311212",
            "telephone_number": "616-897-8473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5333 Maple Hill Ave SE",
            "address_purpose": "LOCATION",
            "city": "Ada",
            "state": "MI",
            "postal_code": "493017717",
            "country_code": "US",
            "telephone_number": "616-828-3879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHANNON",
        "middle_name": "LORRAINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-21",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101006594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Lowell, MI
• Providers in Lowell, 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 Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.