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General NPI Number Information
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NPI Number | 1316827066
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Entity Type | Organization
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Legal Business Name | DUNCAN LAKE SPEECH THERAPY, LLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 2450 44TH ST SE STE 201
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City | KENTWOOD
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State | MI
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Zip | 49512-9081
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Country | US
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Telephone | 616-528-0870
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Fax | 616-591-5684
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Provider Business Mailing Address
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Address Line | 2450 44TH ST SE STE 201
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City | KENTWOOD
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State | MI
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Zip | 49512-9081
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Country | US
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Telephone | 616-528-0870
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Fax | 616-591-5684
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | TAMIKO E TESHIMA
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Credential | MA, CCC-SLP
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Telephone | 616-528-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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