Doctor Name: | MICHELLE LYNNE DERRYBERRY |
NPI Number: | 1174702930 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC/SLP |
License Number: | 13354 |
Business Practice Address: | 5046 Courtney Way El Dorado Hills, CA - 957625478 |
Business Phone Number: | 9163976974 |
Business Fax Number: | 9163585582 |
Mailing Address: | 5046 Courtney Way, EL DORADO HILLS |
State: | CA |
Postal Code: | 957625478 |
Phone Number: | 9163976974 |
Fax Number: | 9163585582 |
NPI Enumeration Date: | 10/29/2007 |
NPI Last Update Date: | 10/29/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 13354 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |