Provider Demographics
NPI:1821424730
Name:PERDUE, MICHELLE LYNN (MED)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:PERDUE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 SENECA ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-1371
Mailing Address - Country:US
Mailing Address - Phone:814-678-8627
Mailing Address - Fax:814-676-1016
Practice Address - Street 1:248 SENECA ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-1371
Practice Address - Country:US
Practice Address - Phone:814-678-8627
Practice Address - Fax:814-676-1016
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool