Provider Demographics
NPI:1023412004
Name:TRYBUS LANZENDORFER, MICHELLE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:TRYBUS LANZENDORFER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:TRYBUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:101 ANDERSON ROAD
Mailing Address - Street 2:PO BOX 114
Mailing Address - City:NORTHERN CAMBRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15714
Mailing Address - Country:US
Mailing Address - Phone:814-244-0930
Mailing Address - Fax:
Practice Address - Street 1:101 ANDERSON ROAD
Practice Address - Street 2:
Practice Address - City:NORTHERN CAMBRIA
Practice Address - State:PA
Practice Address - Zip Code:15714-0114
Practice Address - Country:US
Practice Address - Phone:814-244-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist