Provider Demographics
NPI:1093973646
Name:NEAL, MICHELLE L (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:NEAL
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 1:904 HIDDEN ACRES AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474-1039
Mailing Address - Country:US
Mailing Address - Phone:931-379-5502
Mailing Address - Fax:
Practice Address - Street 1:904 HIDDEN ACRES AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474-1039
Practice Address - Country:US
Practice Address - Phone:931-379-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003726A235Z00000X
TN6054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22003726AOtherSTATE LICENSE
IN235Z00000XOtherTAXONOMY