Healthcare Provider Details

I. General information

NPI: 1487005807
Provider Name (Legal Business Name): PEDIATRIC SPEECH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 FOREST MEADOWS CT SE
GRAND RAPIDS MI
49546-7931
US

IV. Provider business mailing address

2471 FOREST MEADOWS CT SE
GRAND RAPIDS MI
49546-7931
US

V. Phone/Fax

Practice location:
  • Phone: 616-291-9762
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JILL MILLER
Title or Position: OWNER
Credential:
Phone: 616-291-9762