Teri Renee Mickevicius, M.A. CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Gregory, MI
NPI 1225600976 · NPPES record last updated Jul 13, 2021
Key facts
- NPI
- 1225600976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 7101001364 (MI)
- Practice address
- 7941 Stonehedge Valley Dr
Gregory, MI 48137-9752 - Phone
- (734) 649-9261
- NPI assigned
- Jul 13, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7101001364 | MI | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7101001364 | MI | Yes |
Addresses
Primary practice location
7941 Stonehedge Valley Dr
Gregory, MI 48137-9752
Mailing address
7941 Stonehedge Valley Dr
Gregory, MI 48137-9752
Phone (734) 649-9261
Other providers in Gregory, MI
- Cheri Ann Fair
- GLV Innovations
- Andrea Jan Lasichak
- Lauren Rill LLC
- Lotus Neurorehabilitation, LLC
- Annette Marie Pringle
- Lauren Rill
- Sacred Heart Adult Care Home, Inc.
- Stacy Marie Sledz
- Gail Vanamberg
All providers in Gregory, MI · Speech-Language Pathologist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.