Provider Demographics
NPI:1497399729
Name:STICKEL, MICHELLE (SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:STICKEL
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:BERKELEY COUNTY BOARD OF EDUCATION
Mailing Address - Street 2:1453 WINCHESTER AVENUE
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405
Mailing Address - Country:US
Mailing Address - Phone:304-267-3595
Mailing Address - Fax:
Practice Address - Street 1:BERKELEY COUNTY BOARD OF EDUCATION
Practice Address - Street 2:1453 WINCHESTER AVENUE
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405
Practice Address - Country:US
Practice Address - Phone:304-267-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSLP-1991OtherWV BOARD OF EXAMINERS CARD