Provider Demographics
NPI:1255477519
Name:TERRY, MICHELLE JEAN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEAN
Last Name:TERRY
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 1:15128 SHINGLE OAK RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7688
Mailing Address - Country:US
Mailing Address - Phone:704-930-8996
Mailing Address - Fax:
Practice Address - Street 1:15128 SHINGLE OAK RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7688
Practice Address - Country:US
Practice Address - Phone:704-930-8996
Practice Address - Fax:954-474-7437
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist