Basic Information
Provider Information
NPI: 1003296385
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MIDDLETON
FirstName: MICHELLE
MiddleName: RENEE
NamePrefix:  
NameSuffix:  
Credential: AU.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: NEUROHR
OtherFirstName: MICHELLE
OtherMiddleName: RENEE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: AUD
OtherLastNameType: 1
Mailing Information
Address1: 2401 GILLHAM RD
Address2: HEARING AND SPEECH CLINIC
City: KANSAS CITY
State: MO
PostalCode: 641084619
CountryCode: US
TelephoneNumber: 8169604009
FaxNumber:  
Practice Location
Address1: 2401 GILLHAM RD
Address2: HEARING AND SPEECH CLINIC
City: KANSAS CITY
State: MO
PostalCode: 641084619
CountryCode: US
TelephoneNumber: 8169604009
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/02/2015
LastUpdateDate: 08/25/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X2280KSN Speech, Language and Hearing Service ProvidersAudiologist 
231H00000X2015017644MOY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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