Provider Demographics
NPI:1639290281
Name:VINCENT, MICHELLE MARIE KRUSE (AUD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE KRUSE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:KRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:161 ZOE DR
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-6076
Mailing Address - Country:US
Mailing Address - Phone:316-204-4336
Mailing Address - Fax:
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:BLDG 285
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:337-531-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2008231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist