Provider Demographics
NPI:1184862526
Name:RAPPAPORT, MICHELE C (MS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:C
Last Name:RAPPAPORT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5629 SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-1905
Mailing Address - Country:US
Mailing Address - Phone:510-236-7707
Mailing Address - Fax:
Practice Address - Street 1:5629 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-1905
Practice Address - Country:US
Practice Address - Phone:510-236-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5079319Medicaid