Provider Demographics
NPI:1871647321
Name:ELFRINK, MICHELE GAIL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:GAIL
Last Name:ELFRINK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:GAIL
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2064B WALTON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3701
Mailing Address - Country:US
Mailing Address - Phone:573-204-0429
Mailing Address - Fax:573-204-0471
Practice Address - Street 1:3264 COUNTY ROAD 316
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-9122
Practice Address - Country:US
Practice Address - Phone:573-450-1272
Practice Address - Fax:573-651-0210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO469392419Medicaid