Provider Demographics
NPI:1477711778
Name:FROESE, MICHELLE DENICE (AUD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DENICE
Last Name:FROESE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-1017
Mailing Address - Country:US
Mailing Address - Phone:817-335-2583
Mailing Address - Fax:817-335-2597
Practice Address - Street 1:1730 W RANDOL MILL RD
Practice Address - Street 2:SUITE 190
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3054
Practice Address - Country:US
Practice Address - Phone:817-265-1466
Practice Address - Fax:817-459-0756
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51183237600000X, 231H00000X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130622Medicare PIN