MEDICARE: CANDICE MICHEL M.A., 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
1	235Z00000X	Speech-Language Pathologist	12207	OH

General Provider Information

NPI Number	:	1336695774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE MICHEL M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	351 BONNETT ST SW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 LEE ELLEN PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-3712
Country	:	US
Telephone Number	:	614-365-5099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	08/26/2016

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Directions to “ CANDICE MICHEL M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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