Provider Demographics
NPI:1912180159
Name:NORRIS, MICHELE ROSE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ROSE
Last Name:NORRIS
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ROSE
Other - Last Name:DOMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:687 NORTHWIND LN
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6665
Mailing Address - Country:US
Mailing Address - Phone:815-403-3870
Mailing Address - Fax:
Practice Address - Street 1:801 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-2827
Practice Address - Country:US
Practice Address - Phone:224-842-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist