Provider Demographics
NPI:1184905358
Name:DUPONT, MICHAEL A (MS,CCC/SLP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:DUPONT
Suffix:
Gender:M
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 1:707 WESTMORELAND AVE
Mailing Address - Street 2:SYRACUSE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2635
Mailing Address - Country:US
Mailing Address - Phone:315-425-9029
Mailing Address - Fax:
Practice Address - Street 1:707 WESTMORELAND AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2635
Practice Address - Country:US
Practice Address - Phone:315-425-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006718-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist