Provider Demographics
NPI:1699116772
Name:CARDEN, MICHELLE WESSON
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:WESSON
Last Name:CARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 SUNDERLAND CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1970
Mailing Address - Country:US
Mailing Address - Phone:678-358-7237
Mailing Address - Fax:404-464-0776
Practice Address - Street 1:1892 HOSEA L WILLIAMS DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2239
Practice Address - Country:US
Practice Address - Phone:404-720-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist