Provider Demographics
NPI:1619126125
Name:CONOVER, MICHELLE K (PH D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:K
Last Name:CONOVER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 CANOGA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-5052
Mailing Address - Country:US
Mailing Address - Phone:818-340-7700
Mailing Address - Fax:818-340-7701
Practice Address - Street 1:5950 CANOGA AVE STE 100
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-5052
Practice Address - Country:US
Practice Address - Phone:818-340-7700
Practice Address - Fax:818-340-7701
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21871103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist