Provider Demographics
NPI:1205294238
Name:KOLAR, MICHELLE ELLIOTT (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELLIOTT
Last Name:KOLAR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25215 WILD SAGE
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8543
Mailing Address - Country:US
Mailing Address - Phone:210-323-6223
Mailing Address - Fax:
Practice Address - Street 1:31320 INTERSTATE 10 W
Practice Address - Street 2:SUITE D
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-5027
Practice Address - Country:US
Practice Address - Phone:830-755-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist