Provider Demographics
NPI:1861144545
Name:MICHAEL, AUSTIN JAMES (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7042
Mailing Address - Country:US
Mailing Address - Phone:419-487-3777
Mailing Address - Fax:
Practice Address - Street 1:411 WESTERN ROW RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1438
Practice Address - Country:US
Practice Address - Phone:513-398-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty