Provider Demographics
NPI:1700509924
Name:MICHAEL, CAILIN BROOKE (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CAILIN
Middle Name:BROOKE
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 THORNY OYSTER WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-9703
Mailing Address - Country:US
Mailing Address - Phone:740-988-6713
Mailing Address - Fax:
Practice Address - Street 1:2126 HIGHWAY 9 E STE C4
Practice Address - Street 2:
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-5753
Practice Address - Country:US
Practice Address - Phone:843-734-1076
Practice Address - Fax:843-734-1107
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14284593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC14284593OtherASHA