Provider Demographics
NPI:1285835785
Name:REILLY, MICHAEL PATRICK (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:REILLY
Suffix:
Gender:M
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 1:4029 N MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-1233
Mailing Address - Country:US
Mailing Address - Phone:267-716-8463
Mailing Address - Fax:215-230-4580
Practice Address - Street 1:4029 N MALLARD LN
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-1233
Practice Address - Country:US
Practice Address - Phone:267-716-8463
Practice Address - Fax:215-230-4580
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003169L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist