Provider Demographics
NPI:1124536040
Name:AMES, MICHELLE SUSAN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUSAN
Last Name:AMES
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 1:19 PARRIS ST APT 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2955
Mailing Address - Country:US
Mailing Address - Phone:207-805-7024
Mailing Address - Fax:
Practice Address - Street 1:19 PARRIS ST APT 8
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2955
Practice Address - Country:US
Practice Address - Phone:207-805-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist