Provider Demographics
NPI:1548608201
Name:ROTTINGHAUS, MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ROTTINGHAUS
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 1:4725 MERLE HAY RD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1983
Mailing Address - Country:US
Mailing Address - Phone:515-331-3190
Mailing Address - Fax:
Practice Address - Street 1:2300 SWAN LAKE BLVD
Practice Address - Street 2:SUITE #103
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9707
Practice Address - Country:US
Practice Address - Phone:319-334-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist