Provider Demographics
NPI:1083272991
Name:WASHART, MICHELE ANN (MS; CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:WASHART
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 1:603 THAMES WAY APT G
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4228
Mailing Address - Country:US
Mailing Address - Phone:856-371-6569
Mailing Address - Fax:
Practice Address - Street 1:1200 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3045
Practice Address - Country:US
Practice Address - Phone:410-396-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist