Healthcare Provider Details

I. General information

NPI: 1821647488
Provider Name (Legal Business Name): AAC ON THE LAKESHORE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E BELTLINE AVE NE STE 220
GRAND RAPIDS MI
49506-1267
US

IV. Provider business mailing address

330 E BELTLINE AVE NE STE 220
GRAND RAPIDS MI
49506-1267
US

V. Phone/Fax

Practice location:
  • Phone: 616-260-3013
  • Fax: 616-935-0748
Mailing address:
  • Phone: 616-260-3013
  • Fax: 616-935-0748

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: MS. LINDA A KELLEY
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA, CCC-SLP
Phone: 616-260-3013