Provider Demographics
NPI:1639794969
Name:DURHAM, MICHELLE LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:GUNTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:359 COMMONWEALTH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3867
Mailing Address - Country:US
Mailing Address - Phone:276-669-6331
Mailing Address - Fax:
Practice Address - Street 1:359 COMMONWEALTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3867
Practice Address - Country:US
Practice Address - Phone:276-669-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001781231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist