Healthcare Provider Details

I. General information

NPI: 1134222342
Provider Name (Legal Business Name): MICHELLE PEARL MENEFEE-DUNN MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST
CLIFTON FORGE VA
24422
US

IV. Provider business mailing address

251 W RIVERSIDE ST
COVINGTON VA
24426-1216
US

V. Phone/Fax

Practice location:
  • Phone: 540-863-1620
  • Fax: 540-863-1625
Mailing address:
  • Phone: 540-960-0275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12004019
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: