Provider Demographics
NPI:1043291446
Name:KISTLER, JAMEY MELISSA GITCHEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JAMEY
Middle Name:MELISSA GITCHEL
Last Name:KISTLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7094 S PERE MARQUETTE HWY
Mailing Address - Street 2:
Mailing Address - City:PENTWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49449-9669
Mailing Address - Country:US
Mailing Address - Phone:231-233-1065
Mailing Address - Fax:231-723-1520
Practice Address - Street 1:7094 S PERE MARQUETTE HWY
Practice Address - Street 2:
Practice Address - City:PENTWATER
Practice Address - State:MI
Practice Address - Zip Code:49449-9669
Practice Address - Country:US
Practice Address - Phone:231-233-1065
Practice Address - Fax:231-723-1520
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12007745235Z00000X
MI7101000468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist