Provider Demographics
NPI:1538315148
Name:SHAFFER, MICHELLE LESLIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LESLIE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 GARNERCREST RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9621
Mailing Address - Country:US
Mailing Address - Phone:910-686-7353
Mailing Address - Fax:
Practice Address - Street 1:313 GARNERCREST RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9621
Practice Address - Country:US
Practice Address - Phone:910-686-7353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist