Provider Demographics
NPI:1548733660
Name:REITBERGER, MICHELE SUSAN
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:SUSAN
Last Name:REITBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 YEATMAN CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3060
Mailing Address - Country:US
Mailing Address - Phone:240-888-6600
Mailing Address - Fax:
Practice Address - Street 1:10 YEATMAN CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3060
Practice Address - Country:US
Practice Address - Phone:240-888-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00434235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD24681284OtherGEHA