| Lumen Pediatric Therapy, Llc | |
|
26210 Harper Ave Ste 200 Saint Clair Shores MI 48081-2203 | |
| (888) 485-8636 | |
| (586) 218-3367 |
| Full Name | Lumen Pediatric Therapy, Llc |
|---|---|
| Speciality | Speech-Language Pathologist |
| Location | 26210 Harper Ave Ste 200, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Nicholle Mehr (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8884858636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lumen Pediatric Therapy, Llc 26210 Harper Ave Ste 200 Saint Clair Shores MI 48081-2203 Ph: (888) 485-8636 | Lumen Pediatric Therapy, Llc 26210 Harper Ave Ste 200 Saint Clair Shores MI 48081-2203 Ph: (888) 485-8636 |
| NPI Number | 1407573942 |
|---|---|
| Provider Enumeration Date | 10/25/2022 |
| Last Update Date | 08/18/2024 |
| Certification Date | 08/18/2024 |
| Medicare PECOS PAC ID | 8628442407 |
|---|---|
| Medicare Enrollment ID | O20230317000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407573942 | NPI | - | NPPES |
| Provider Name | Michelle Marie Kriegshauser |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1497355960 PECOS PAC ID: 4082026091 Enrollment ID: I20201216001851 |
| Provider Name | Jessica Dawn Young |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1083220321 PECOS PAC ID: 9830567767 Enrollment ID: I20221123002419 |
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