Provider Demographics
NPI:1194519553
Name:CANTRELL, MICHELLE FAITH
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FAITH
Last Name:CANTRELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13096 LE PARC UNIT 69
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4022
Mailing Address - Country:US
Mailing Address - Phone:909-358-0049
Mailing Address - Fax:
Practice Address - Street 1:222 N MOUNTAIN AVE STE 109A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5715
Practice Address - Country:US
Practice Address - Phone:909-610-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94422355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant