MEDICARE: MICHELLE SCHAKE

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

General Provider Information

NPI Number	:	1811320302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SCHAKE

Provider Business Mailing Address
First Line	:	702 COTTONWOOD ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4824
Country	:	US
Telephone Number	:	701-746-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 CHERRY ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7400
Country	:	US
Telephone Number	:	701-746-2265
Fax Number	:	701-746-2266

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

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	12/10/2013

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Directions to “ MICHELLE SCHAKE ” Practice Location

Language	Start Address	Practice Location

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