Provider Demographics
NPI:1013244912
Name:MESSEMER, MICHELLE STEPHANIE (MEDCCCSLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:STEPHANIE
Last Name:MESSEMER
Suffix:
Gender:F
Credentials:MEDCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BRUSH DR
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-2616
Mailing Address - Country:US
Mailing Address - Phone:203-546-8720
Mailing Address - Fax:
Practice Address - Street 1:11 BRUSH DR
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-2616
Practice Address - Country:US
Practice Address - Phone:203-546-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007044-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist