MEDICARE: MRS. MICHELE MARIE FLAGG M.A.,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	010001-1	NY

General Provider Information

NPI Number	:	1174586036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE MARIE FLAGG M.A.,CCC-SLP

Provider Business Mailing Address
First Line	:	463 OGDEN PARMA TOWN LINE RD
Second Line	:
City	:	SPENCERPORT
State	:	NY
Zip	:	14559-1151
Country	:	US
Telephone Number	:	585-352-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 LATONA RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2700
Country	:	US
Telephone Number	:	585-723-2140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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