Basic Information
| Provider Information | |||||||||
| NPI: | 1093973646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 HIDDEN ACRES AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384741039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313795502 | ||||||||
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| Practice Location | |||||||||
| Address1: | 904 HIDDEN ACRES AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384741039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313795502 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2008 | ||||||||
| LastUpdateDate: | 12/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 22003726A | IN | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 6054 | TN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 22003726A | 01 | IN | STATE LICENSE | OTHER | 235Z00000X | 01 | IN | TAXONOMY | OTHER |