Lakeshore Speech and Language Therapy, PLLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

11079 Issued in NC

Legal business name

LAKESHORE SPEECH AND LANGUAGE THERAPY, PLLC

Practice address

105 Palos Verde Dr
Mooresville, NC 28117-9070

Phone

(602) 540-9041

NPI assigned

Sep 8, 2017

Last updated

Sep 8, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Michelle Patel, MS, CCC-SLPNPI 1437495470

Title

Speech-Language Pathologist

Phone

(602) 540-9041

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Patel

  • Speech-Language Pathologist
  • Mooresville, NC
  • NPI 1437495470
  Authorized official Same address or phone

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

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504828800000",
    "number": "1780102905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 PALOS VERDE DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 PALOS VERDE DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179070",
            "telephone_number": "602-540-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE SPEECH AND LANGUAGE THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2017-09-08",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "602-540-9041",
        "authorized_official_credential": "MS, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "11079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2017; 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.