Provider Demographics
NPI:1114063302
Name:MINERICH, MICHELLE SUZANNE (MS SLP CCC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:MINERICH
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 AIRLINE RD
Mailing Address - Street 2:APT 1204
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412
Mailing Address - Country:US
Mailing Address - Phone:361-881-3515
Mailing Address - Fax:
Practice Address - Street 1:600 ELIZABETH STREET
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-881-3515
Practice Address - Fax:361-883-3213
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101942235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist