Provider Demographics
NPI:1699787788
Name:PARK-CHAIMOWITZ, MICHELE ADRIENNE (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ADRIENNE
Last Name:PARK-CHAIMOWITZ
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1539 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-2161
Mailing Address - Country:US
Mailing Address - Phone:561-784-2295
Mailing Address - Fax:561-753-7022
Practice Address - Street 1:12955 PALMS WEST DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4993
Practice Address - Country:US
Practice Address - Phone:561-753-7010
Practice Address - Fax:561-753-7022
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist