Provider Demographics
NPI:1922382852
Name:INGRAM, MICHELLE M (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:141 N MERAMEC AVE
Mailing Address - Street 2:STE 110A
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3750
Mailing Address - Country:US
Mailing Address - Phone:314-277-0441
Mailing Address - Fax:314-863-7545
Practice Address - Street 1:141 N MERAMEC AVE
Practice Address - Street 2:STE 110A
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3750
Practice Address - Country:US
Practice Address - Phone:314-277-0441
Practice Address - Fax:314-863-7545
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist