Provider Demographics
NPI:1972705093
Name:TSOSIE, MICHELLE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:TSOSIE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-61 BOX 5000-JMM
Mailing Address - Street 2:RRTP
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:928-266-3534
Mailing Address - Fax:
Practice Address - Street 1:#4 CONE HILL HOUSING RD.
Practice Address - Street 2:
Practice Address - City:ROUGH ROCK
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-266-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12082020OtherASHA
AZSLP4524OtherADHS