Healthcare Provider Details

I. General information

NPI: 1861307316
Provider Name (Legal Business Name): JENNIFER TOPHAM CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 E MANNSIDING RD
CLARE MI
48617-9753
US

IV. Provider business mailing address

4508 N ISLAND DR
SANFORD MI
48657-9571
US

V. Phone/Fax

Practice location:
  • Phone: 989-418-8652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008583
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: