Provider Demographics
NPI:1184828543
Name:ROCK, MICHELLE BLOW (MS-CCC, SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BLOW
Last Name:ROCK
Suffix:
Gender:F
Credentials:MS-CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 SAM BASS COURT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7624
Mailing Address - Country:US
Mailing Address - Phone:817-980-9230
Mailing Address - Fax:
Practice Address - Street 1:4480 BELTWAY DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3705
Practice Address - Country:US
Practice Address - Phone:972-505-6787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100611OtherLICENSE NUMBER