MEDICARE: MRS. MICHELLE A HERBST MA 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	011976-1	NY

General Provider Information

NPI Number	:	1295900371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE A HERBST MA CCC-SLP

Provider Business Mailing Address
First Line	:	47 NOTTINGHAM DR
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-2114
Country	:	US
Telephone Number	:	631-924-6255
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 NOTTINGHAM DR
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-2114
Country	:	US
Telephone Number	:	631-924-6255
Fax Number	:

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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