Provider Demographics
NPI:1316255532
Name:FEIDEN, MICHELE A (MS,CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:A
Last Name:FEIDEN
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WALLFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1522
Mailing Address - Country:US
Mailing Address - Phone:518-373-7076
Mailing Address - Fax:
Practice Address - Street 1:61 WALLFLOWER DR
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1522
Practice Address - Country:US
Practice Address - Phone:518-373-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist