Provider Demographics
NPI:1275150591
Name:MCCABE, MICHAELA KATE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:KATE
Last Name:MCCABE
Suffix:
Gender:F
Credentials:MA, 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:W5381 ANGELS LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:WI
Mailing Address - Zip Code:53125-1197
Mailing Address - Country:US
Mailing Address - Phone:262-215-7079
Mailing Address - Fax:
Practice Address - Street 1:4908 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2506
Practice Address - Country:US
Practice Address - Phone:262-215-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.005948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist