Provider Demographics
NPI:1699046052
Name:DUVALL, MICHELE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:DUVALL
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 1:3052 LOCK HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:CLIMAX
Mailing Address - State:NC
Mailing Address - Zip Code:27233-9701
Mailing Address - Country:US
Mailing Address - Phone:336-392-6491
Mailing Address - Fax:
Practice Address - Street 1:625 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2943
Practice Address - Country:US
Practice Address - Phone:336-434-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist