Provider Demographics
NPI:1013694520
Name:NORTHERN GEMS SPEECH-LANGUAGE AND FEEDING THERAPY, LLC
Entity Type:Organization
Organization Name:NORTHERN GEMS SPEECH-LANGUAGE AND FEEDING THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FREIMARK
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:989-701-4909
Mailing Address - Street 1:1958 MILDRED DR
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9445
Mailing Address - Country:US
Mailing Address - Phone:989-701-4909
Mailing Address - Fax:
Practice Address - Street 1:220 W HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1220
Practice Address - Country:US
Practice Address - Phone:989-701-4909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7101007385OtherMICHIGAN SLP LICENSE
MI1831873090OtherNPI TYPE 1