Doctor Name: | JENNA MICHELSON |
NPI Number: | 1346646866 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC-SLP |
License Number: | 004609 |
Business Practice Address: | 1931 Black Rock Tpke Attn: Credentialing Fairfield, CT - 068253506 |
Business Phone Number: | 2033324363 |
Business Fax Number: | 2033306761 |
Mailing Address: | 1931 Black Rock Tpke, Attn: Credentialing FAIRFIELD |
State: | CT |
Postal Code: | 068253506 |
Phone Number: | 2033324363 |
Fax Number: | 2033306761 |
NPI Enumeration Date: | 11/11/2014 |
NPI Last Update Date: | 11/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 004609 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
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 |