Provider Demographics
NPI:1386779098
Name:ROQUEVERT, MICHAEL ALAN (MS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:ROQUEVERT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 51322
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5622
Mailing Address - Country:US
Mailing Address - Phone:270-777-9283
Mailing Address - Fax:270-777-8283
Practice Address - Street 1:181 W PROFESSIONAL PARK CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3250
Practice Address - Country:US
Practice Address - Phone:270-843-5300
Practice Address - Fax:270-843-5383
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist