Provider Demographics
NPI:1083686109
Name:TORRES, MICHAELA DOCKERY (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:DOCKERY
Last Name:TORRES
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6255
Mailing Address - Country:US
Mailing Address - Phone:910-679-8385
Mailing Address - Fax:910-679-8387
Practice Address - Street 1:3901 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6255
Practice Address - Country:US
Practice Address - Phone:910-679-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11454870OtherCAQH
NC137XYOtherBCBS
NCD6004OtherMEDCOST
NC7411780Medicaid
9344871OtherPHCS