MEDICARE: MICHELLE CLOCKMAN M.S. 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	7101006656	MI

General Provider Information

NPI Number	:	1306310974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CLOCKMAN M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	41225 CROSSBOW CIR APT 104
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-3140
Country	:	US
Telephone Number	:	616-901-1541
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 MITZI ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49445-3232
Country	:	US
Telephone Number	:	231-744-1641
Fax Number	:

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

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	12/10/2019

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Directions to “ MICHELLE CLOCKMAN M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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