Provider Demographics
NPI:1215061668
Name:HITZ, MICHELLE LYNN (SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:HITZ
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 1:210 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-1420
Mailing Address - Country:US
Mailing Address - Phone:217-357-9202
Mailing Address - Fax:217-357-0585
Practice Address - Street 1:210 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321-1420
Practice Address - Country:US
Practice Address - Phone:217-357-9202
Practice Address - Fax:217-357-0585
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist