Provider Demographics
NPI:1275689796
Name:DICONCILIO, MICHELLE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DICONCILIO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SPILLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDCCC-SLP
Mailing Address - Street 1:3301 LOGANBERRY CT
Mailing Address - Street 2:
Mailing Address - City:EFLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27243-8908
Mailing Address - Country:US
Mailing Address - Phone:919-740-0189
Mailing Address - Fax:
Practice Address - Street 1:2415 SUNNYFIELD CT
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9380
Practice Address - Country:US
Practice Address - Phone:919-704-4047
Practice Address - Fax:919-537-8093
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412161Medicaid