Michael Eric Prentice, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

16601 Issued in CA

Practice address

645 Tamalpais Dr Ste B
Corte Madera, CA 94925-1613

Phone

(415) 924-2444

NPI assigned

Apr 5, 2022

Last updated

Apr 5, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Speech Therapy Marin

  dba Child Development Center of Marin

  • Speech-Language Pathologist
  • Mill Valley, CA
  • NPI 1205338332
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1487395208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 MARINA LAKES DR",
            "city": "RICHMOND",
            "state": "CA",
            "postal_code": "948047448",
            "telephone_number": "510-372-6671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 TAMALPAIS DR STE B",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251613",
            "telephone_number": "415-924-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENTICE",
        "first_name": "MICHAEL",
        "middle_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "16601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Physiotherapy Associates, Inc. (Select Physical Therapy)
• Jonathan Pofsky, MFT
• Erica Anne Posner, MFT
• Post Street Occupational Medicine PC
• Gordana Potrebic, PSY.D.
• Deon Pretorius, RPH
• Kelly D Prothero, LCSW
• Psychserv Medical Corporation
• Jedidiah Purses, AMFT
• Susan Theresa Quigley, MFT

• Speech-Language Pathologist in Corte Madera, CA
• Providers in Corte Madera, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.