Provider Demographics
NPI:1225709488
Name:MICHEL, MARA GABRIELLE (AUD)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:GABRIELLE
Last Name:MICHEL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SHERMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3711
Mailing Address - Country:US
Mailing Address - Phone:847-535-6464
Mailing Address - Fax:224-271-4870
Practice Address - Street 1:1630 SHERMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3711
Practice Address - Country:US
Practice Address - Phone:847-535-6464
Practice Address - Fax:224-271-4870
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004304231H00000X
IL147002005231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist