Provider Demographics
NPI:1841313830
Name:LEVITT, MICHELLE ELLYSE (MS, CCC SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELLYSE
Last Name:LEVITT
Suffix:
Gender:F
Credentials:MS, CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3947
Mailing Address - Country:US
Mailing Address - Phone:973-661-0238
Mailing Address - Fax:
Practice Address - Street 1:89 BALDWIN TER
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3654
Practice Address - Country:US
Practice Address - Phone:973-696-3928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS003973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist