Provider Demographics
NPI:1205119179
Name:MCCORKLE, MICHELE (SLP)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 CHAMBERLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2911
Mailing Address - Country:US
Mailing Address - Phone:423-304-6478
Mailing Address - Fax:
Practice Address - Street 1:6600 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:BUILDING 400 , SUITE 125
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6773
Practice Address - Country:US
Practice Address - Phone:770-225-8421
Practice Address - Fax:678-587-9993
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2341235Z00000X
VA2202010400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist