Provider Demographics
NPI:1770610347
Name:CYR, MICHELLE LOUISE (BS)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:CYR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14673 W ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2027
Mailing Address - Country:US
Mailing Address - Phone:623-217-2010
Mailing Address - Fax:
Practice Address - Street 1:14673 W ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2027
Practice Address - Country:US
Practice Address - Phone:623-217-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist