Provider Demographics
NPI:1134400856
Name:MCDANIEL, MICHELLE PEARSON (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PEARSON
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BEATRICE LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-4607
Mailing Address - Country:US
Mailing Address - Phone:601-724-1114
Mailing Address - Fax:601-267-8333
Practice Address - Street 1:730 HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-5802
Practice Address - Country:US
Practice Address - Phone:601-267-8333
Practice Address - Fax:601-267-5550
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist