Provider Demographics
NPI:1174033187
Name:PLUMMER, MICHELLE M (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:MOSCINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2828 KENDRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9043
Mailing Address - Country:US
Mailing Address - Phone:630-803-2186
Mailing Address - Fax:
Practice Address - Street 1:2828 KENDRIDGE LN
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9043
Practice Address - Country:US
Practice Address - Phone:630-803-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist