Provider Demographics
NPI:1063798296
Name:TSCHETTER-THOMSON, MICHELE L (MS,CCC,SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:L
Last Name:TSCHETTER-THOMSON
Suffix:
Gender:F
Credentials:MS,CCC,SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1101 W VICKERY BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-1025
Mailing Address - Country:US
Mailing Address - Phone:682-885-6294
Mailing Address - Fax:682-885-1135
Practice Address - Street 1:1101 W VICKERY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1025
Practice Address - Country:US
Practice Address - Phone:682-885-6294
Practice Address - Fax:682-885-1135
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist