Provider Demographics
NPI:1427199611
Name:SIEGMAN, MICHELLE C (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:SIEGMAN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-1302
Mailing Address - Country:US
Mailing Address - Phone:765-489-1388
Mailing Address - Fax:765-489-4228
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-1302
Practice Address - Country:US
Practice Address - Phone:765-489-1388
Practice Address - Fax:765-489-4228
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002155A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000215972OtherBLUE CROSS BLUE SHIELD
IN000000215972OtherBLUE CROSS BLUE SHIELD
IN190010Medicare ID - Type Unspecified