Provider Demographics
NPI:1346550563
Name:RUTHERFORD, MICHELE (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:PO 2712
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27515
Mailing Address - Country:US
Mailing Address - Phone:919-932-7160
Mailing Address - Fax:919-338-1086
Practice Address - Street 1:1703 LEGION RD
Practice Address - Street 2:STE 201
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2371
Practice Address - Country:US
Practice Address - Phone:919-932-7160
Practice Address - Fax:919-338-1086
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist