Provider Demographics
NPI:1295220440
Name:DACY-NICHOLS, MICHELE MORGAN (SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MORGAN
Last Name:DACY-NICHOLS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:MORGAN
Other - Last Name:DACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8910 PURDUE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6136
Mailing Address - Country:US
Mailing Address - Phone:800-603-6046
Mailing Address - Fax:317-884-3388
Practice Address - Street 1:901 SOMERBY DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3490
Practice Address - Country:US
Practice Address - Phone:800-603-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist