Provider Demographics
NPI:1427429109
Name:CHACON, MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CHACON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LINDLEY
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12301 LAKE UNDERHILL RD
Mailing Address - Street 2:STE 260
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4508
Mailing Address - Country:US
Mailing Address - Phone:407-249-3344
Mailing Address - Fax:407-378-2978
Practice Address - Street 1:12301 LAKE UNDERHILL RD
Practice Address - Street 2:STE 260
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4508
Practice Address - Country:US
Practice Address - Phone:407-249-3344
Practice Address - Fax:407-378-2978
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist