Provider Demographics
NPI:1083440762
Name:BLOCK, MICHAELA MARIE (SLP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:MARIE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6045
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91003-6045
Mailing Address - Country:US
Mailing Address - Phone:626-429-4253
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 6045
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91003-6045
Practice Address - Country:US
Practice Address - Phone:626-429-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist