Individual provider Active NPI

Lily Soule, CF-SLP

  • Speech-Language Pathologist
  • Grand Haven, MI
National Provider Identifier
1891421616
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
16760 Lincoln St
Grand Haven, MI 49417-8864
Phone
(616) 935-3300
NPI assigned
Jul 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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 MI Primary

Addresses

Primary practice location

16760 Lincoln St
Grand Haven, MI 49417-8864

Mailing address

PO Box 419885
Boston, MA 02241-9885
Phone (888) 830-4125

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231122002195 MI Practitioner - Qualified Speech Language Pathologist 2466800925 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mitten State Pediatric Therapy LLC Speech-Language Pathologist CurrentSince Nov 7, 2023 Accepting new patients
Ivyrehab Northern PT, LLC PastSince Jul 31, 2022 Accepting new patients

Locations

5258 Plainfield Ave NE
Ste A
Grand Rapids, MI 49525
Phone (616) 466-4068

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": "1658707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1891421616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 419885",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022419885",
            "telephone_number": "888-830-4125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16760 LINCOLN ST",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494178864",
            "telephone_number": "616-935-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOULE",
        "first_name": "LILY",
        "credential": "CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-25",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.