Provider Demographics
NPI:1073124608
Name:RICKEY, MICHELLE DANIELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DANIELLE
Last Name:RICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 WINKLER DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1652
Mailing Address - Country:US
Mailing Address - Phone:330-345-6671
Mailing Address - Fax:
Practice Address - Street 1:741 WINKLER DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1652
Practice Address - Country:US
Practice Address - Phone:330-345-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist