Provider Demographics
NPI:1528497377
Name:TRISTANI, MICHELLE LAURA (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LAURA
Last Name:TRISTANI
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LAURA
Other - Last Name:DION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:10 CARMEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052
Mailing Address - Country:US
Mailing Address - Phone:508-654-2382
Mailing Address - Fax:508-359-2459
Practice Address - Street 1:10 CARMEN CIRCLE
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052
Practice Address - Country:US
Practice Address - Phone:508-654-2382
Practice Address - Fax:508-359-2459
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist