Healthcare Provider Details

I. General information

NPI: 1558250902
Provider Name (Legal Business Name): RALEIGH BROOKE SHIMRACK SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19901 DIX TOLEDO HWY
BROWNSTOWN TWP MI
48183-1039
US

IV. Provider business mailing address

2127 ARBOR CIR W APT 201
YPSILANTI MI
48197-3430
US

V. Phone/Fax

Practice location:
  • Phone: 313-631-3360
  • Fax:
Mailing address:
  • Phone: 724-674-8938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009505
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: