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General NPI Number Information
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NPI Number | 1063673978
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD UPSHAW SLP
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Gender | Male
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 07/21/2011
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Provider Practice Location Address
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Address Line | 820 W SUNNYSIDE AVE APT 3A
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City | CHICAGO
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State | IL
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Zip | 60640-6179
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Country | US
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Telephone | 312-286-9903
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Fax |
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Provider Business Mailing Address
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Address Line | 820 W SUNNYSIDE AVE APT 3A
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City | CHICAGO
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State | IL
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Zip | 60640-6179
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Country | US
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Telephone | 312-286-9903
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Fax |
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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 | 2202005513
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License Number State | VA
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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 | 146.009753
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License Number State | IL
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