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General NPI Number Information
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NPI Number | 1043291446
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Entity Type | Individual
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Provider Name | JAMEY MELISSA GITCHEL KISTLER M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/11/2005
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Last Update Date | 01/26/2018
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Provider Practice Location Address
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Address Line | 7094 S PERE MARQUETTE HWY
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City | PENTWATER
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State | MI
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Zip | 49449-9669
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Country | US
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Telephone | 231-233-1065
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Fax | 231-723-1520
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Provider Business Mailing Address
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Address Line | 7094 S PERE MARQUETTE HWY
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City | PENTWATER
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State | MI
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Zip | 49449-9669
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Country | US
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Telephone | 231-233-1065
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Fax | 231-723-1520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12007745
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101000468
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License Number State | MI
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