Provider Demographics
NPI:1316423486
Name:QUICK, MICHELLE (MS SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:QUICK
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 W MORENO ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-2033
Mailing Address - Country:US
Mailing Address - Phone:850-428-0665
Mailing Address - Fax:877-215-7951
Practice Address - Street 1:7552 NAVARRE PKWY UNIT 47
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7309
Practice Address - Country:US
Practice Address - Phone:850-428-0665
Practice Address - Fax:877-215-7951
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY905OtherSLP LICENSE