Individual provider Active NPI

Tamiko E Teshima, M.A., CCC-SLP

  • Speech-Language Pathologist
  • Kentwood, MI
National Provider Identifier
1689238727
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7101005604 Issued in MI
Practice address
2450 44TH St SE Ste 201
Kentwood, MI 49512-9081
Phone
(616) 528-0870
Fax
(616) 591-5684
NPI assigned
Apr 24, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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 7101005604 MI Primary

Addresses

Primary practice location

2450 44TH St SE Ste 201
Kentwood, MI 49512-9081

Mailing address

10170 Duncan Lake Ave SE
Caledonia, MI 49316-9413
Phone (727) 807-0511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201217002652 MI Practitioner - Qualified Speech Language Pathologist 7113339011 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
7101005604MIMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Duncan Lake Speech Therapy, LLC Speech-Language Pathologist CurrentSince Sep 1, 2020 Accepting new patients
Duncan Lake Speech Therapy, LLC Current Accepting new patients

Locations

2450 44th St SE
Ste 201
Kentwood, MI 49512
Phone (616) 224-3636

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1689238727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10170 DUNCAN LAKE AVE SE",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493169413",
            "telephone_number": "727-807-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 44TH ST SE STE 201",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495129081",
            "telephone_number": "616-528-0870",
            "fax_number": "616-591-5684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESHIMA",
        "first_name": "TAMIKO",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-24",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7101005604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.