Healthcare Provider Details

I. General information

NPI: 1154905842
Provider Name (Legal Business Name): MICHELLE MARIA VONDEBSCHITZ M.ED., CCC/ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 05/08/2021
Certification Date: 05/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7265 PORTAGE ST NW UNIT B
MASSILLON OH
44646-6101
US

IV. Provider business mailing address

700 E MAPLE ST
NORTH CANTON OH
44720-2608
US

V. Phone/Fax

Practice location:
  • Phone: 330-249-1153
  • Fax:
Mailing address:
  • Phone: 330-313-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.05460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: