Provider Demographics
NPI:1205398377
Name:ARMISTEAD, MICHELLE JOHNSON (SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOHNSON
Last Name:ARMISTEAD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-3452
Mailing Address - Country:US
Mailing Address - Phone:251-209-2068
Mailing Address - Fax:
Practice Address - Street 1:705 17TH ST STE 407
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3514
Practice Address - Country:US
Practice Address - Phone:706-321-0930
Practice Address - Fax:706-571-0960
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3942235Z00000X
GASLP010367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist