| The Shoreline Center Llc | |
|
16925 Ability Way Grand Haven MI 49417-9325 | |
| (616) 935-7606 | |
| (616) 935-7607 |
| Full Name | The Shoreline Center Llc |
|---|---|
| Speciality | Psychologist |
| Location | 16925 Ability Way, Grand Haven, Michigan |
| Authorized Official Name and Position | Dan Radley (OWNER) |
| Authorized Official Contact | 6169357606 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Shoreline Center Llc 16925 Ability Way Grand Haven MI 49417-9325 Ph: (616) 935-7606 | The Shoreline Center Llc 16925 Ability Way Grand Haven MI 49417-9325 Ph: (616) 935-7606 |
| NPI Number | 1942689708 |
|---|---|
| Provider Enumeration Date | 05/27/2015 |
| Last Update Date | 08/03/2021 |
| Certification Date | 08/03/2021 |
| Medicare PECOS PAC ID | 5294030938 |
|---|---|
| Medicare Enrollment ID | O20160218000349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942689708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301014390 (Michigan) | Primary |
| 261QD1600X | Clinic/center - Developmental Disabilities | (* (Not Available)) | Secondary |
| Provider Name | Tammi Beth Ryan |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033303649 PECOS PAC ID: 9638267412 Enrollment ID: I20071112000406 |
| Provider Name | Lauren Burkhardt |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1104304005 PECOS PAC ID: 5294070157 Enrollment ID: I20181220002034 |
| Provider Name | Hannah Slp Miller |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1588264964 PECOS PAC ID: 2567860588 Enrollment ID: I20211006000168 |
| Provider Name | Shannon Hulliberger |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1780359539 PECOS PAC ID: 9830562958 Enrollment ID: I20230310000184 |
| Provider Name | Ellen Brown |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1316643174 PECOS PAC ID: 1658744784 Enrollment ID: I20230310000228 |
| Provider Name | Megan Kupris |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699498071 PECOS PAC ID: 8426421553 Enrollment ID: I20230310000410 |
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