NPIMap

Organization Active NPI

Shine on Pediatric Therapy, PLLC

  • Speech-Language Pathologist
  • Lake Zurich, IL
National Provider Identifier
1982392056
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
SHINE ON PEDIATRIC THERAPY, PLLC
Practice address
340 Denberry Dr
Lake Zurich, IL 60047-7932
Phone
(847) 800-9530
NPI assigned
Apr 26, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Authorized official

Name
Miss Diana Maria Vanstedum, MHS., CCC-SLP/LNPI 1144847237
Title
Speech-Language Pathologist
Phone
(847) 800-9530

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

340 Denberry Dr
Lake Zurich, IL 60047-7932

Mailing address

21897 N Inglenook CT
Deer Park, IL 60010-9731
Phone (847) 800-9530

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1682467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1982392056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21897 N INGLENOOK CT",
            "city": "DEER PARK",
            "state": "IL",
            "postal_code": "600109731",
            "telephone_number": "847-800-9530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 DENBERRY DR",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600477932",
            "telephone_number": "847-800-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE ON PEDIATRIC THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-26",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "VANSTEDUM",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "847-800-9530",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MHS., CCC-SLP/L"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Zurich, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; 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.