Provider Demographics
NPI:1700291937
Name:STANFORD, MICHELLE (MS, BS, SLT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:MS, BS, SLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-2109
Mailing Address - Country:US
Mailing Address - Phone:803-641-2624
Mailing Address - Fax:
Practice Address - Street 1:1000 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-2109
Practice Address - Country:US
Practice Address - Phone:803-641-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist