Provider Demographics
NPI:1023735990
Name:KRUEBBE, MICHELLE (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:KRUEBBE
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 1:107 MEADOWBROOK ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-2240
Mailing Address - Country:US
Mailing Address - Phone:903-220-9563
Mailing Address - Fax:
Practice Address - Street 1:11109 US HIGHWAY 84 E
Practice Address - Street 2:
Practice Address - City:JOAQUIN
Practice Address - State:TX
Practice Address - Zip Code:75954-2479
Practice Address - Country:US
Practice Address - Phone:936-269-3128
Practice Address - Fax:936-269-9433
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist