Provider Demographics
NPI:1801410162
Name:ESCUE, MICHELLE ELIZABETH VICTORIA (MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH VICTORIA
Last Name:ESCUE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-1395
Mailing Address - Country:US
Mailing Address - Phone:309-472-1347
Mailing Address - Fax:
Practice Address - Street 1:110 CARVER LN
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-3052
Practice Address - Country:US
Practice Address - Phone:670-430-9282
Practice Address - Fax:234-030-9387
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.016010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist