Active NPI
Mary Christine Michener, M.S. CCC SLP
- Speech-Language Pathologist
- Twin Falls, ID
National Provider Identifier
1386710069
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP-1400
- Practice address
- 1525 Addison Ave E Ste 6
Twin Falls, ID 83301-5383 - Phone
- (208) 420-1316
- Fax
- (208) 733-0120
- NPI assigned
- Nov 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP-1400 | ID | Primary |
Addresses
Primary practice location
1525 Addison Ave E Ste 6
Twin Falls, ID 83301-5383
Mailing address
1175 E 900 S
Eden, ID 83325-5009
Phone (208) 825-5778
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010141489 | Other | ID | BLUE SHIELD PROVIDER NUMB |
| SP656 | Other | ID | BLUE CROSS PROVIDER NUMBE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-1400 | ID | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386710069",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1175 E 900 S",
"city": "EDEN",
"state": "ID",
"postal_code": "833255009",
"telephone_number": "208-825-5778",
"fax_number": "208-733-0120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 ADDISON AVE E STE 6",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015383",
"telephone_number": "208-420-1316",
"fax_number": "208-733-0120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHENER",
"first_name": "MARY",
"middle_name": "CHRISTINE",
"name_prefix": "Mrs.",
"credential": "M.S. CCC SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "ID",
"license": "SLP-1400",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROVIDER NUMB",
"identifier": "000010141489",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER NUMBE",
"identifier": "SP656",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.