MEDICARE: MICHELLE ELIZABETH LANDECHE

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

General Provider Information

NPI Number	:	1477731552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ELIZABETH LANDECHE

Provider Business Mailing Address
First Line	:	5004 LONG LAKE CIR
Second Line	:	#302
City	:	LAKELAND
State	:	FL
Zip	:	33805-9577
Country	:	US
Telephone Number	:	407-572-4315
Fax Number	:

Provider Business Practice Location Address
First Line	:	5004 LONG LAKE CIR
Second Line	:	#302
City	:	LAKELAND
State	:	FL
Zip	:	33805-9577
Country	:	US
Telephone Number	:	407-572-4315
Fax Number	:

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

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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Directions to “ MICHELLE ELIZABETH LANDECHE ” Practice Location

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