Doctor Name: | MRS. MICHELLE CAROL SOUTHERLY |
NPI Number: | 1750407425 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 394 |
Business Practice Address: | Rr 1 Box 34 A Augusta, WV - 267049706 |
Business Phone Number: | 3044968284 |
Business Fax Number: | 3044969761 |
Mailing Address: | Rr 1 Box 34 A, AUGUSTA |
State: | WV |
Postal Code: | 267049706 |
Phone Number: | 3044968284 |
Fax Number: | 3044969761 |
NPI Enumeration Date: | 03/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 394 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
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 |