| Doctor Name: | MRS. MARY CHRISTINE MICHENER |
| NPI Number: | 1386710069 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. CCC SLP |
| License Number: | SLP-1400 |
| Business Practice Address: | 1525 Addison Ave E Ste 6 Twin Falls, ID - 833015383 |
| Business Phone Number: | 2084201316 |
| Business Fax Number: | 2087330120 |
| Mailing Address: | 1175 E 900 S, EDEN |
| State: | ID |
| Postal Code: | 833255009 |
| Phone Number: | 2088255778 |
| Fax Number: | 2087330120 |
| NPI Enumeration Date: | 11/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP-1400 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| 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 |