Provider Demographics
NPI:1689792988
Name:LACROIX, MICHELE GERTZULIN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:GERTZULIN
Last Name:LACROIX
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:GERTZULIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:4817 E PLACITA ABREVADERO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1253
Mailing Address - Country:US
Mailing Address - Phone:520-245-9052
Mailing Address - Fax:
Practice Address - Street 1:4710 E 29TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-6447
Practice Address - Country:US
Practice Address - Phone:520-745-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist