Provider Demographics
NPI:1669693024
Name:TUCKER, MICHELLE ANDERSON (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANDERSON
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 24TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2816
Mailing Address - Country:US
Mailing Address - Phone:727-252-9566
Mailing Address - Fax:727-328-7879
Practice Address - Street 1:2365 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7005
Practice Address - Country:US
Practice Address - Phone:727-328-7879
Practice Address - Fax:727-328-7879
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist