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NPI Code Detail

MEDICARE: MICHELLE KRISTEN NIMMO MS, CCC-SLP

MEDICARE: MICHELLE KRISTEN NIMMO MS, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist06051MD

General Provider Information

NPI Number : 1083958979
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE KRISTEN NIMMO MS, CCC-SLP
Provider Business Mailing Address
First Line : 2612 BRADWELL CT
Second Line :
City : PARKVILLE
State : MD
Zip : 21234-1519
Country : US
Telephone Number : 631-495-6456
Fax Number :
Provider Business Practice Location Address
First Line : 1881 TELEGRAPH RD
Second Line :
City : RISING SUN
State : MD
Zip : 21911-2018
Country : US
Telephone Number : 410-658-6555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2012
Last Update Date : 11/16/2012

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Directions to “ MICHELLE KRISTEN NIMMO MS, CCC-SLP” Practice Location

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