Provider Demographics
NPI:1023201456
Name:AHMED, MICHAEL MUSHTAQ (EDDCCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MUSHTAQ
Last Name:AHMED
Suffix:
Gender:M
Credentials:EDDCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8560 LA MANCHA LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3287
Mailing Address - Country:US
Mailing Address - Phone:928-526-0034
Mailing Address - Fax:
Practice Address - Street 1:8560 LA MANCHA LN
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3287
Practice Address - Country:US
Practice Address - Phone:928-526-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5478235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist