Provider Demographics
NPI: | 1821647488 |
---|---|
Name: | AAC ON THE LAKESHORE, PLLC |
Entity Type: | Organization |
Organization Name: | AAC ON THE LAKESHORE, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SPEECH-LANGUAGE PATHOLOGIST |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | LINDA |
Authorized Official - Middle Name: | KELLEY |
Authorized Official - Last Name: | HARTMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MA, CCC-SLP |
Authorized Official - Phone: | 616-260-3013 |
Mailing Address - Street 1: | 11219 BROWN AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALLENDALE |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49401-9405 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 616-260-3013 |
Mailing Address - Fax: | 616-935-0748 |
Practice Address - Street 1: | 11219 BROWN AVE |
Practice Address - Street 2: | |
Practice Address - City: | ALLENDALE |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49401-9405 |
Practice Address - Country: | US |
Practice Address - Phone: | 616-260-3013 |
Practice Address - Fax: | 616-935-0748 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-09-06 |
Last Update Date: | 2020-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |