Provider Demographics
NPI:1942756085
Name:SOOS, MICHELLE (BS, MA, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SOOS
Suffix:
Gender:F
Credentials:BS, MA, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73373 COUNTRY CLUB DR
Mailing Address - Street 2:#3318
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-8624
Mailing Address - Country:US
Mailing Address - Phone:716-909-3088
Mailing Address - Fax:
Practice Address - Street 1:73373 COUNTRY CLUB DR
Practice Address - Street 2:#3318
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-8624
Practice Address - Country:US
Practice Address - Phone:716-909-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist