Provider Demographics
NPI:1669537338
Name:HOUSTON, MICHELLE A (MS, SLP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 QUINTRELL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1804
Mailing Address - Country:US
Mailing Address - Phone:704-543-6998
Mailing Address - Fax:
Practice Address - Street 1:8405 QUINTRELL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-1804
Practice Address - Country:US
Practice Address - Phone:704-543-6998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist