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General NPI Number Information
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NPI Number | 1508538448
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Entity Type | Individual
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Provider Name | MICHELLE MARIE MISIC MS CCC SLP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 1311 ROUND ROCK AVE
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City | ROUND ROCK
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State | TX
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Zip | 78681-4999
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Country | US
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Telephone | 512-464-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 116 WALLIN FARMS DR
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City | HUTTO
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State | TX
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Zip | 78634-5682
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Country | US
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Telephone | 915-820-3246
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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 | 104369
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License Number State | TX
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