MEDICARE: MICHELLE MARIE MISSLER MA/PPS

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	103TS0200X	School Psychologist	210176088	CA

General Provider Information

NPI Number	:	1770374035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARIE MISSLER MA/PPS

Provider Business Mailing Address
First Line	:	1500 LIZZIE ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-3062
Country	:	US
Telephone Number	:	805-549-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 LIZZIE ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-3062
Country	:	US
Telephone Number	:	805-549-1200
Fax Number	:

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

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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