Doctor Name: | MRS. MICHELLE BOTTO-BLAKE |
NPI Number: | 1437340353 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | SLP005780 |
Business Practice Address: | 190 Ketton Xing Duluth, GA - 300977139 |
Business Phone Number: | 7708469856 |
Business Fax Number: | |
Mailing Address: | 190 Ketton Xing, DULUTH |
State: | GA |
Postal Code: | 300977139 |
Phone Number: | 7708469856 |
Fax Number: | |
NPI Enumeration Date: | 08/06/2007 |
NPI Last Update Date: | 08/06/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP005780 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
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 |