Provider Demographics
NPI:1881099901
Name:COYLE, MICHELLE MCINTYRE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MCINTYRE
Last Name:COYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 FAIRFIELD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2531
Mailing Address - Country:US
Mailing Address - Phone:504-343-7903
Mailing Address - Fax:
Practice Address - Street 1:5021 FAIRFIELD ST FL 2
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2531
Practice Address - Country:US
Practice Address - Phone:504-343-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist