Provider Demographics
NPI:1114138047
Name:HAVLIK, MICHELLE MARIE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:HAVLIK
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 1:9113 26TH PL
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1009
Mailing Address - Country:US
Mailing Address - Phone:708-387-0117
Mailing Address - Fax:708-387-0157
Practice Address - Street 1:9113 26TH PL
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1009
Practice Address - Country:US
Practice Address - Phone:708-302-5260
Practice Address - Fax:708-387-0157
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist