Provider Demographics
NPI:1386981959
Name:SPENCER, MICHELE ANNE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANNE
Last Name:SPENCER
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 1:19713 NE 160TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-9448
Mailing Address - Country:US
Mailing Address - Phone:425-788-7403
Mailing Address - Fax:
Practice Address - Street 1:14715 BEL RED RD
Practice Address - Street 2:BLDG. G - SUITE 103
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3940
Practice Address - Country:US
Practice Address - Phone:425-502-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60232176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist