Healthcare Provider Details

I. General information

NPI: 1528886595
Provider Name (Legal Business Name): MICHAEL MONROE M.S., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 DEVELOPMENT DR
LANSING MI
48911-4213
US

IV. Provider business mailing address

2544 MARTINA DR APT 1
HOLT MI
48842-2145
US

V. Phone/Fax

Practice location:
  • Phone: 517-706-0421
  • Fax:
Mailing address:
  • Phone: 810-922-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009185
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: