Provider Demographics
NPI:1477050268
Name:EBELING, MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:EBELING
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25189 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63452-2351
Mailing Address - Country:US
Mailing Address - Phone:573-209-3586
Mailing Address - Fax:
Practice Address - Street 1:25189 HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MO
Practice Address - Zip Code:63452-2351
Practice Address - Country:US
Practice Address - Phone:573-209-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist