Provider Demographics
NPI:1225352362
Name:LATZO, MICHELE MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MARIE
Last Name:LATZO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:MARIE
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5416 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1427
Mailing Address - Country:US
Mailing Address - Phone:814-899-8600
Mailing Address - Fax:814-898-1919
Practice Address - Street 1:5416 E LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1427
Practice Address - Country:US
Practice Address - Phone:814-899-8600
Practice Address - Fax:814-898-1919
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002354L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist