Individual provider Active NPI

Sarah Joy Kidder

  • Speech-Language Pathologist
  • Grand Rapids, MI
National Provider Identifier
1871369157
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
7152000501 Issued in MI
Practice address
2922 Fuller Ave NE Ste 107
Grand Rapids, MI 49505-3459
Phone
(616) 570-0925
NPI assigned
Nov 28, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 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 7152000501 MI Primary

Addresses

Primary practice location

2922 Fuller Ave NE Ste 107
Grand Rapids, MI 49505-3459

Mailing address

2922 Fuller Ave NE Ste 107
Grand Rapids, MI 49505-3459

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231213000754 MI Practitioner - Qualified Speech Language Pathologist 0345699591 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7152000501MIMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Building Blocks Foundation, Inc Speech-Language Pathologist CurrentSince Dec 1, 2023 Accepting new patients
Building Blocks Therapy Services, LLC CurrentSince Dec 1, 2023 Accepting new patients
Caya Therapies LLC Past Accepting new patients

Locations

2922 Fuller Ave NE
Ste 107
Grand Rapids, MI 49505
Phone (248) 921-7814

Organizations & group practices 3

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": "1701129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1871369157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2922 FULLER AVE NE STE 107",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495053459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2922 FULLER AVE NE STE 107",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495053459",
            "telephone_number": "616-570-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDDER",
        "first_name": "SARAH",
        "middle_name": "JOY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-28",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": "7152000501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.