=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487207502
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE MCCHESNEY MA, CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2019
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 474 BENNINGTON AVE
-----------------------------------------------------
City | YOUNGSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44505-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-744-6900
-----------------------------------------------------
Fax | 330-743-1157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 RAMSEY RD
-----------------------------------------------------
City | SANDY LAKE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16145-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-889-8098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | YS02808
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP.16167
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SL017942
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------