Provider Demographics
NPI:1992031918
Name:MERLO, MICHELLE NICOLE (M A CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:MERLO
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63101-1015
Mailing Address - Country:US
Mailing Address - Phone:314-633-5300
Mailing Address - Fax:
Practice Address - Street 1:5101 MCREE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2019
Practice Address - Country:US
Practice Address - Phone:314-776-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009024851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist