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General NPI Number Information
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NPI Number | 1750796553
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Entity Type | Individual
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Provider Name | MRS. JACKIE Z. MICHAELIDES
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Gender | Female
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Dates
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Enumeration Date | 07/01/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 2681 GREGORY RD CHESHIRE ELEMENTARY SCHOOL-OLENTANGY LOCAL SCHOOLS
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City | DELAWARE
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State | OH
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Zip | 43015
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Country | US
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Telephone | 740-657-5750
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Fax | 740-657-5799
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Provider Business Mailing Address
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Address Line | 2080 CITYGATE DR EDUCATIONAL SERVICE CENTER OF CENTRAL OHIO
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City | COLUMBUS
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State | OH
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Zip | 43219
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Country | US
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Telephone | 614-445-3750
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Fax | 614-445-3767
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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 | SP.6482
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License Number State | OH
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