Provider Demographics
NPI:1154905842
Name:VONDEBSCHITZ, MICHELLE MARIA (MED, CCC/ SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIA
Last Name:VONDEBSCHITZ
Suffix:
Gender:F
Credentials:MED, CCC/ SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2608
Mailing Address - Country:US
Mailing Address - Phone:330-313-5525
Mailing Address - Fax:
Practice Address - Street 1:7265 PORTAGE ST NW UNIT B
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6101
Practice Address - Country:US
Practice Address - Phone:330-249-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.05460235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty