Provider Demographics
NPI:1316375785
Name:GEORGE, MICHELE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2323
Mailing Address - Country:US
Mailing Address - Phone:304-615-9788
Mailing Address - Fax:304-424-4016
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-424-4087
Practice Address - Fax:304-424-4016
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1329235Z00000X
OHSP 9335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP 9335OtherOHIO BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
WVSLP-1329OtherWEST VIRGINIA BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
12153623OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION