Provider Demographics
NPI:1508218181
Name:ADAMS, MICHAELENE JOY (MA)
Entity Type:Individual
Prefix:MRS
First Name:MICHAELENE
Middle Name:JOY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 EASTGATE DR
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-3618
Mailing Address - Country:US
Mailing Address - Phone:605-670-7444
Mailing Address - Fax:
Practice Address - Street 1:224 S UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-3226
Practice Address - Country:US
Practice Address - Phone:605-677-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD384-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist