MEDICARE: MICHELLE MARIE AUSTIN 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	SP01115	RI

General Provider Information

NPI Number	:	1295065829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARIE AUSTIN CCC-SLP

Provider Business Mailing Address
First Line	:	12 SPRING DR
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-3026
Country	:	US
Telephone Number	:	401-486-7697
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 SPRING DR
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-3026
Country	:	US
Telephone Number	:	401-486-7697
Fax Number	:

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

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	01/09/2016

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Directions to “ MICHELLE MARIE AUSTIN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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