Provider Demographics
NPI:1801228416
Name:LAI, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 INTERNATIONAL PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1865
Mailing Address - Country:US
Mailing Address - Phone:972-521-6273
Mailing Address - Fax:972-338-9378
Practice Address - Street 1:1771 INTERNATIONAL PKWY STE 107
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1865
Practice Address - Country:US
Practice Address - Phone:972-521-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2073235Z00000X
TX108103235Z00000X
TX109789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109789OtherTEXAS DEPARTMENT OF LICENSING AND REGISTRATION
14061151OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION (ASHA)