Provider Demographics
NPI:1841745510
Name:DASSO, MICHELLE TAIMI
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TAIMI
Last Name:DASSO
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 1:1504 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3113
Mailing Address - Country:US
Mailing Address - Phone:309-762-9552
Mailing Address - Fax:309-762-9610
Practice Address - Street 1:1504 13TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3113
Practice Address - Country:US
Practice Address - Phone:309-762-9552
Practice Address - Fax:309-762-9610
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.003896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist