Provider Demographics
NPI:1679981468
Name:CHADROM, MICHELE RUTH (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RUTH
Last Name:CHADROM
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 1:85 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6337
Mailing Address - Country:US
Mailing Address - Phone:303-284-6114
Mailing Address - Fax:
Practice Address - Street 1:85 FOREST ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6337
Practice Address - Country:US
Practice Address - Phone:303-284-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP0000966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist