Provider Demographics
NPI:1528193232
Name:NORMAN, MICHAEL CLARK (MCD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CLARK
Last Name:NORMAN
Suffix:
Gender:M
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 RIDGELAKE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3836
Mailing Address - Country:US
Mailing Address - Phone:504-833-4174
Mailing Address - Fax:504-833-4173
Practice Address - Street 1:3350 RIDGELAKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3836
Practice Address - Country:US
Practice Address - Phone:504-833-4174
Practice Address - Fax:504-833-4173
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist