Provider Demographics
NPI:1982088332
Name:VAN DER WESTHUIZEN, MICHAELA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:VAN DER WESTHUIZEN
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 1:469 SHEEPSHANK DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2093
Mailing Address - Country:US
Mailing Address - Phone:402-490-6768
Mailing Address - Fax:
Practice Address - Street 1:469 SHEEPSHANK DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2093
Practice Address - Country:US
Practice Address - Phone:402-490-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist