Provider Demographics
NPI:1699222455
Name:WISHERD, MICHELLE C (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:C
Last Name:WISHERD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COLD CREEK RANCH RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59647-8503
Mailing Address - Country:US
Mailing Address - Phone:406-240-7249
Mailing Address - Fax:
Practice Address - Street 1:10 COLD CREEK RANCH RD
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:MT
Practice Address - Zip Code:59647-8503
Practice Address - Country:US
Practice Address - Phone:406-240-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSP 1004235Z00000X
TX112281235Z00000X
CASP 24151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist