Provider Demographics
NPI:1326472432
Name:HAZELIP, MICHELLE S (MHS, CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:S
Last Name:HAZELIP
Suffix:
Gender:F
Credentials:MHS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 150TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3421
Mailing Address - Country:US
Mailing Address - Phone:708-945-3505
Mailing Address - Fax:
Practice Address - Street 1:3924 150TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3421
Practice Address - Country:US
Practice Address - Phone:708-945-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242002874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist