Provider Demographics
NPI:1881919447
Name:LAVISKY, MICHELE
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:LAVISKY
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 1:6160 WILES RD
Mailing Address - Street 2:APARTMENT 302
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4302
Mailing Address - Country:US
Mailing Address - Phone:954-504-3990
Mailing Address - Fax:
Practice Address - Street 1:23315 BLUE WATER CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7053
Practice Address - Country:US
Practice Address - Phone:561-368-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist