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NPI Code Detail

MEDICARE: MICHELLE ANN ICKES PH.D.

MEDICARE: MICHELLE ANN ICKES PH.D.
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
1231H00000XAudiologist2201000510VA

General Provider Information

NPI Number : 1417906694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE ANN ICKES PH.D.
Provider Business Mailing Address
First Line : PO BOX 98
Second Line :
City : WHITE SULPHUR SPRINGS
State : WV
Zip : 24986-0098
Country : US
Telephone Number : 304-536-5030
Fax Number : 304-536-5031
Provider Business Practice Location Address
First Line : 2030 COLONIAL AVE SW
Second Line :
City : ROANOKE
State : VA
Zip : 24015-3204
Country : US
Telephone Number : 540-343-0165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 03/01/2016

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