Healthcare Provider Details

I. General information

NPI: 1306171814
Provider Name (Legal Business Name): SHANA J. RUSH PHD CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANA J. ASBELL PHD

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 05/12/2023
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 PLYMOUTH AVE NE
GRAND RAPIDS MI
49505-6028
US

IV. Provider business mailing address

412 PLYMOUTH AVE NE
GRAND RAPIDS MI
49505-6028
US

V. Phone/Fax

Practice location:
  • Phone: 616-780-0590
  • Fax: 616-984-4559
Mailing address:
  • Phone: 616-780-0590
  • Fax: 616-984-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301013545
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301013545
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: