Provider Demographics
NPI:1336410109
Name:BABB, MICHELLE ERICKA (MA,CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ERICKA
Last Name:BABB
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 1:3019 SW 27TH AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1826
Mailing Address - Country:US
Mailing Address - Phone:352-275-5778
Mailing Address - Fax:
Practice Address - Street 1:3019 SW 27TH AVE
Practice Address - Street 2:STE 202
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1826
Practice Address - Country:US
Practice Address - Phone:352-275-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist