Provider Demographics
NPI:1689944183
Name:FROST, MICHELE LEHTMA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEHTMA
Last Name:FROST
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:MARIE
Other - Last Name:LEHTMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:329 FLAT BUSH DR
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-4528
Mailing Address - Country:US
Mailing Address - Phone:912-713-5301
Mailing Address - Fax:
Practice Address - Street 1:329 FLAT BUSH DR
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-4528
Practice Address - Country:US
Practice Address - Phone:912-713-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist