Provider Demographics
NPI:1811283641
Name:CANTONO, MICHAELINE NICOLE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHAELINE
Middle Name:NICOLE
Last Name:CANTONO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MICHAELINE
Other - Middle Name:NICOLE
Other - Last Name:MAIRONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:614 UPPER WEADLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5454
Mailing Address - Country:US
Mailing Address - Phone:215-760-7811
Mailing Address - Fax:
Practice Address - Street 1:614 UPPER WEADLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-5454
Practice Address - Country:US
Practice Address - Phone:215-760-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist