Provider Demographics
NPI:1235563354
Name:CHURCH, MICHAELA A (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:A
Last Name:CHURCH
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 1:1879 W GENESEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9430
Mailing Address - Country:US
Mailing Address - Phone:315-253-0361
Mailing Address - Fax:
Practice Address - Street 1:1879 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-9430
Practice Address - Country:US
Practice Address - Phone:315-253-0361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist