Provider Demographics
NPI:1588964415
Name:RIDENOUR, MICHELLE ELIZABETH (AUD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24 N SAINT JOSEPH AVE
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2263
Mailing Address - Country:US
Mailing Address - Phone:269-683-0800
Mailing Address - Fax:269-683-7638
Practice Address - Street 1:24 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE C-1
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2263
Practice Address - Country:US
Practice Address - Phone:269-683-0800
Practice Address - Fax:269-683-7638
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIL1853937237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIL1853937OtherSTATE OF MICHIGAN DEPT OF COMMUNITY HEALTH LICENSE