Spark Speech Therapy LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

SPARK SPEECH THERAPY LLC

Practice address

206 N Howard St
Fenton, MI 48430-2195

Phone

(810) 429-9545

NPI assigned

Apr 8, 2024

Organization subpart

No

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

Authorized official

Name

Shae Nimmo, CCC-SLPNPI 1487423588

Title

Owner, Speech Language Pathologist

Phone

(810) 429-9545

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shae Nimmo, CCC-SLP

  • Speech-Language Pathologist
  • Fenton, MI
  • NPI 1487423588
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1801649256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N HOWARD ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302195",
            "telephone_number": "810-429-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N HOWARD ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302195",
            "telephone_number": "810-429-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK SPEECH THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "NIMMO",
        "authorized_official_first_name": "SHAE",
        "authorized_official_title_or_position": "OWNER, SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "810-429-9545",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Lynn Beckman Smith, LPC, NCC
• Colene A. Snowden, AFC PROVIDER
• McKenzie Sobczak, TLLP
• Sonoma Dental Group, P.C.
• Sonoma Dental Group, P.C.
• SSC Fenton Operating Company LLC
• Elizabeth Diane Stamp, LMSW
• Stephanie Stanton, OTR
• Tiffany Starr
• Joseph Paul Starrs, R.PH.

• Speech-Language Pathologist in Fenton, MI
• Providers in Fenton, 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 May 22, 2024; 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.