Provider Demographics
NPI:1699063875
Name:SPICER, MICHELLE RAE (SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RAE
Last Name:SPICER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RAE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-1891
Mailing Address - Fax:
Practice Address - Street 1:501 N COLUMBIA RD STOP 7132
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2817
Practice Address - Country:US
Practice Address - Phone:701-777-3691
Practice Address - Fax:701-777-3845
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist