Organization · NPI-2

Lumen Pediatric Therapy, LLC

Speech-Language Pathologist, · Saint Clair Shores, MI

NPI number1407573942

StatusActive

Last updated in NPPESFeb 11, 2025

Details

NPI: 1407573942
Entity type: Organization (NPI-2)
Legal business name: Lumen Pediatric Therapy, LLC
Organization subpart: No
Enumeration date: Oct 25, 2022
Certification date: Feb 11, 2025
Last updated: Feb 11, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
235Z00000X	Speech-Language Pathologist,	–	–	Yes
103K00000X	Behavior Analyst	–	–
225X00000X	Occupational Therapist	–	–

Practice location

26210 Harper Ave Ste 200
Saint Clair Shores, MI 48081-2203

Phone 888-485-8636 · Fax 586-218-3367

Mailing address

26210 Harper Ave Ste 200
Saint Clair Shores, MI 48081-2203

Phone 888-485-8636

Other practice locations

3250 University Dr Ste 110
Auburn Hills, MI 48326-2391

Phone 888-485-8636 · Fax 586-218-3367

Authorized official

Nicholle Mehr
Chief Executive Officer
8884858636

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