Provider Demographics
NPI:1801308432
Name:BRAND, MICHELLE NADINE (MA, CCC, SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NADINE
Last Name:BRAND
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MCDANIEL AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3976
Mailing Address - Country:US
Mailing Address - Phone:847-859-8007
Mailing Address - Fax:
Practice Address - Street 1:1500 MCDANIEL AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3976
Practice Address - Country:US
Practice Address - Phone:847-859-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146.003426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist