Provider Demographics
NPI:1013928704
Name:WHITE, MICHELLE L (MA,SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials: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 1:4223 HEATHER PARK DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4425
Mailing Address - Country:US
Mailing Address - Phone:832-876-4791
Mailing Address - Fax:
Practice Address - Street 1:4410 W PASADENA BLVD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-3818
Practice Address - Country:US
Practice Address - Phone:832-876-4791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist