Active NPI
Michelle Srivastava
- Speech-Language Pathologist
- Alpharetta, GA
National Provider Identifier
1891258992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP010062
- Practice address
- 11785 Northfall LN Ste 501-502
Alpharetta, GA 30009-7971 - Phone
- (770) 569-2274
- Fax
- (770) 569-7432
- NPI assigned
- Apr 8, 2019
- 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 | SLP010062 | GA | Primary |
Addresses
Primary practice location
11785 Northfall LN Ste 501-502
Alpharetta, GA 30009-7971
Mailing address
21 Forrest PL
Atlanta, GA 30328-4801
Phone (314) 761-1942
Other names 1
- Michelle Kizaur
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP010062 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rand Speech Pathology LLC | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1891258992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 FORREST PL",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303284801",
"telephone_number": "314-761-1942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11785 NORTHFALL LN STE 501-502",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300097971",
"telephone_number": "770-569-2274",
"fax_number": "770-569-7432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SRIVASTAVA",
"first_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-08",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP010062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MICHELLE",
"last_name": "KIZAUR",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Alpharetta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.