Active NPI
Kristin Swanson Polk, MACCC-SLP
- Speech-Language Pathologist
- Linden, MI
National Provider Identifier
1710148366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 09142027
- Practice address
- 4120 Four Lakes Ave
Linden, MI 48451-9445 - Phone
- (810) 629-9334
- NPI assigned
- Jun 17, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 09142027 | MI | Primary |
Addresses
Primary practice location
4120 Four Lakes Ave
Linden, MI 48451-9445
Mailing address
4120 Four Lakes Ave
Linden, MI 48451-9445
Phone (810) 629-9334
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09142027 | Other | MI | COMMERCIAL INSURANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09142027 | MI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213660800000",
"number": "1710148366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4120 FOUR LAKES AVE",
"city": "LINDEN",
"state": "MI",
"postal_code": "484519445",
"telephone_number": "810-629-9334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 FOUR LAKES AVE",
"city": "LINDEN",
"state": "MI",
"postal_code": "484519445",
"telephone_number": "810-629-9334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLK",
"first_name": "KRISTIN",
"middle_name": "SWANSON",
"name_prefix": "Mrs.",
"credential": "MACCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-17",
"last_updated": "2008-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MI",
"license": "09142027",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL INSURANCE",
"identifier": "09142027",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Linden, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.