Chelsea Diane Bruinsma, MA

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

1305 Walker Ave NW
Grand Rapids, MI 49504-4098

Phone

(616) 419-3095

Fax

(616) 419-3147

NPI assigned

Jul 11, 2014

Last updated

Jul 11, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Chelsea Diane Blackmore Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405036800000",
    "number": "1922415876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11877 RITCHIE AVE NE",
            "city": "CEDAR SPRINGS",
            "state": "MI",
            "postal_code": "493199400",
            "telephone_number": "616-560-2987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 WALKER AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495044098",
            "telephone_number": "616-419-3095",
            "fax_number": "616-419-3147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUINSMA",
        "first_name": "CHELSEA",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-11",
        "last_updated": "2014-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHELSEA",
            "last_name": "BLACKMORE",
            "middle_name": "DIANE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James Bruggink, PT
• Shannon Bruin
• Stefanie Bruinooge
• Anna E Bruins-Campbell, MD
• Benjamin J Bruinsma, M.D.
• John David Bruinsma, DDS
• Caitlin Brummel, BSW, QIDP
• Katrina Ann Brummel, PA-C
• Rebecca Marie Brummel, BS
• Scott R Brundage, MD

• Speech-Language Pathologist in Grand Rapids, MI
• Providers in Grand Rapids, 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 Jul 11, 2014; 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.