Provider Demographics
NPI:1629380621
Name:WEISS, MICHELLE HANNAH (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:HANNAH
Last Name:WEISS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 IRVING PL
Mailing Address - Street 2:APT. G21D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 IRVING PL
Practice Address - Street 2:APT. G21D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9701
Practice Address - Country:US
Practice Address - Phone:917-974-2192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019735-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist