Provider Demographics
NPI:1568076594
Name:TSATSOS, MICHELLE ANN
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:TSATSOS
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 1:24918 MASON ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NE
Mailing Address - Zip Code:68069-4434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24918 MASON ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NE
Practice Address - Zip Code:68069-4434
Practice Address - Country:US
Practice Address - Phone:402-312-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020028872235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist