Provider Demographics
NPI:1225184443
Name:KING, MICHELLE (MS, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1566
Mailing Address - Country:US
Mailing Address - Phone:502-595-4459
Mailing Address - Fax:502-635-7853
Practice Address - Street 1:982 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1566
Practice Address - Country:US
Practice Address - Phone:502-595-4459
Practice Address - Fax:502-635-7853
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0110231H00000X
KY0610237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN183870NMedicare PIN
KY0098625Medicare PIN