Provider Demographics
NPI:1588787865
Name:STOYANOFF, MICHELLE ANTOINETTE (SLP)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:STOYANOFF
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MARBLE ARCHWAY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905
Mailing Address - Country:US
Mailing Address - Phone:765-446-1207
Mailing Address - Fax:
Practice Address - Street 1:104 MARBLE ARCH WAY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7622
Practice Address - Country:US
Practice Address - Phone:765-446-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001681A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist