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General NPI Number Information
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NPI Number | 1346552155
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Entity Type | Individual
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Provider Name | MICHELLE ROSALIE VAL-BASKIN M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 256 MASON AVE # C
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3408
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Country | US
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Telephone | 718-226-5998
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Fax |
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Provider Business Mailing Address
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Address Line | 4550 COLONIAL BLVD
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City | FORT MYERS
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State | FL
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Zip | 33966-1017
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Country | US
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Telephone | 239-931-5700
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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 | 017440-1
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License Number State | NY
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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 | SA14538
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License Number State | FL
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