Provider Demographics
NPI:1588800544
Name:ROUSH, MICHAEL L (BC-HIS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:ROUSH
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 MIDDLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4100
Mailing Address - Country:US
Mailing Address - Phone:563-355-3261
Mailing Address - Fax:
Practice Address - Street 1:852 MIDDLE RD STE 104
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4100
Practice Address - Country:US
Practice Address - Phone:563-355-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00591231H00000X
IL2502231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA613376600Medicare PIN