| Doctor Name: | MICHELLE VANDIVIER |
| NPI Number: | 1437568524 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | SA13117 |
| Business Practice Address: | 602 Vonderburg Dr Suite 201 Brandon, FL - 335115900 |
| Business Phone Number: | 8136531149 |
| Business Fax Number: | 8136546644 |
| Mailing Address: | 602 Vonderburg Dr, Suite 201 BRANDON |
| State: | FL |
| Postal Code: | 335115900 |
| Phone Number: | 8136531149 |
| Fax Number: | 8136546644 |
| NPI Enumeration Date: | 08/04/2014 |
| NPI Last Update Date: | 09/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA13117 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| 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 |