Provider Demographics
NPI:1225279912
Name:RICH, MICHELE WEBER (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:WEBER
Last Name:RICH
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 1:2552 AVERY PARK CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2574
Mailing Address - Country:US
Mailing Address - Phone:770-455-4243
Mailing Address - Fax:
Practice Address - Street 1:1000 HOLCOMB WOODS PKWY STE 426
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4717
Practice Address - Country:US
Practice Address - Phone:770-641-8070
Practice Address - Fax:770-698-4178
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist