Provider Demographics
NPI:1659951523
Name:ROUSH, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ROUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13125 LEWIS CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-7801
Mailing Address - Country:US
Mailing Address - Phone:660-909-6915
Mailing Address - Fax:
Practice Address - Street 1:800 HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:64097-7119
Practice Address - Country:US
Practice Address - Phone:816-240-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018030855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist