Provider Demographics
NPI:1316827066
Name:DUNCAN LAKE SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:DUNCAN LAKE SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKO
Authorized Official - Middle Name:E
Authorized Official - Last Name:TESHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:616-528-0870
Mailing Address - Street 1:2450 44TH ST SE STE 201
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9081
Mailing Address - Country:US
Mailing Address - Phone:616-528-0870
Mailing Address - Fax:616-591-5684
Practice Address - Street 1:2450 44TH ST SE STE 201
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-9081
Practice Address - Country:US
Practice Address - Phone:616-528-0870
Practice Address - Fax:616-591-5684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUNCAN LAKE SPEECH THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty