Provider Demographics
NPI:1396064457
Name:SCOTT, MICHELLE KENNEDY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KENNEDY
Last Name:SCOTT
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 1:4534 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2814
Mailing Address - Country:US
Mailing Address - Phone:251-377-5457
Mailing Address - Fax:
Practice Address - Street 1:4534 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2814
Practice Address - Country:US
Practice Address - Phone:251-377-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist