Provider Demographics
NPI:1588815831
Name:WRIGHT, MICHEL L (SLP)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GENERAL SOMERVELL ST NE
Mailing Address - Street 2:HATHORNE ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123
Mailing Address - Country:US
Mailing Address - Phone:505-299-0796
Mailing Address - Fax:
Practice Address - Street 1:420 GENERAL SOMERVELL ST NE
Practice Address - Street 2:HATHORNE ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1150
Practice Address - Country:US
Practice Address - Phone:505-299-0796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid