Provider Demographics
NPI:1720155286
Name:SPADY, MICHELLE LEE (MS, CCC-SLP, ATP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEE
Last Name:SPADY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, ATP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:HINDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP, ATP
Mailing Address - Street 1:1106 MORNINGSIDE PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3060
Mailing Address - Country:US
Mailing Address - Phone:404-249-6387
Mailing Address - Fax:
Practice Address - Street 1:3166 CHEROKEE ST NW STE 101
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2883
Practice Address - Country:US
Practice Address - Phone:678-290-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist