{
"Npi": {
"NPI": "1558250902",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHIMRACK",
"FirstName": "RALEIGH",
"MiddleName": "BROOKE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "SLP-CCC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2127 ARBOR CIR W APT 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YPSILANTI",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48197-3430",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-674-8938",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19901 DIX TOLEDO HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BROWNSTOWN TWP",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48183-1039",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-631-3360",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/01/2025",
"LastUpdateDate": "07/01/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "7101009505",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}