Healthcare Provider Details

I. General information

NPI: 1568476695
Provider Name (Legal Business Name): MICHELLE M. VERHEYEN M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE MS 785
MILWAUKEE WI
53226-3518
US

IV. Provider business mailing address

1970 ELM TREE RD
ELM GROVE WI
53122-1115
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2934
  • Fax:
Mailing address:
  • Phone: 262-641-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number321-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: