Provider Demographics
NPI:1134222342
Name:MENEFEE-DUNN, MICHELLE PEARL (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PEARL
Last Name:MENEFEE-DUNN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1216
Mailing Address - Country:US
Mailing Address - Phone:540-960-0275
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422
Practice Address - Country:US
Practice Address - Phone:540-863-1620
Practice Address - Fax:540-863-1625
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12004019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA208195OtherANTHEM BCBS
VA541217983OtherTAX ID
VI004978358Medicaid