Provider Demographics
NPI:1215069117
Name:SERRANO, MICHELE SHERIE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:SHERIE
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W BROADWAY
Mailing Address - Street 2:STE A540
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101
Mailing Address - Country:US
Mailing Address - Phone:858-247-1785
Mailing Address - Fax:844-946-2985
Practice Address - Street 1:1440 COLUMBIA ST APT 2001
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3483
Practice Address - Country:US
Practice Address - Phone:415-866-8260
Practice Address - Fax:844-946-2985
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17150235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3108OtherCOLORADO DORA
CASP 17150OtherCALIFORNIA SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY BOARD
TX117335OtherTEXAS DEPT OF LICENSING AND REGULATION
12082520OtherAMERICAN SPEECH & HEARING ASSOCIATION