Provider Demographics
NPI:1275068728
Name:GINEX, MICHELLE CHRISTINE (MHS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:GINEX
Suffix:
Gender:F
Credentials:MHS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 159TH PL
Mailing Address - Street 2:APT 102
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6704
Mailing Address - Country:US
Mailing Address - Phone:708-248-3403
Mailing Address - Fax:
Practice Address - Street 1:7510 159TH PL
Practice Address - Street 2:APT 102
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6704
Practice Address - Country:US
Practice Address - Phone:708-248-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist