Provider Demographics
NPI:1629213921
Name:DEVALL, MICHELE A (SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:A
Last Name:DEVALL
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 1:1437 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-2406
Mailing Address - Country:US
Mailing Address - Phone:225-270-8083
Mailing Address - Fax:
Practice Address - Street 1:1437 N 27TH ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-2406
Practice Address - Country:US
Practice Address - Phone:225-270-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist