Provider Demographics
NPI:1821345232
Name:MICHAELREE, JAN ELIZABETH (MS, CCC/SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:ELIZABETH
Last Name:MICHAELREE
Suffix:
Gender:F
Credentials:MS, CCC/SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 CLEARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-2301
Mailing Address - Country:US
Mailing Address - Phone:314-435-4085
Mailing Address - Fax:
Practice Address - Street 1:4725 CLEARWOOD LN
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-2301
Practice Address - Country:US
Practice Address - Phone:314-435-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012026102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist