Provider Demographics
NPI:1407550809
Name:SKELLEY, MICHELLE L (SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:SKELLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 STONEBRIDGE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2158
Mailing Address - Country:US
Mailing Address - Phone:629-221-0364
Mailing Address - Fax:615-691-7133
Practice Address - Street 1:72 STONEBRIDGE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2158
Practice Address - Country:US
Practice Address - Phone:615-306-3693
Practice Address - Fax:615-691-7133
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN01090816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist