Provider Demographics
NPI:1114232402
Name:MICHAUD, DEBBIE (MA)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FAWN CT
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1931
Mailing Address - Country:US
Mailing Address - Phone:207-989-4859
Mailing Address - Fax:
Practice Address - Street 1:142 ELM ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-3130
Practice Address - Country:US
Practice Address - Phone:207-368-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist