Provider Demographics
NPI:1245407956
Name:EDPAO, MICHELLE T
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:EDPAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2693 MC LARREN CT
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-7192
Mailing Address - Country:US
Mailing Address - Phone:708-646-8470
Mailing Address - Fax:
Practice Address - Street 1:5720 STONERIDGE MALL RD
Practice Address - Street 2:#390
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2828
Practice Address - Country:US
Practice Address - Phone:925-847-7825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist