Provider Demographics
NPI:1174590822
Name:KANE, MICHELLE LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LYNN
Last Name:KANE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 N BRANDON CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4514
Mailing Address - Country:US
Mailing Address - Phone:913-558-0921
Mailing Address - Fax:
Practice Address - Street 1:621 W 21ST ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-8498
Practice Address - Country:US
Practice Address - Phone:316-733-1349
Practice Address - Fax:316-733-2419
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist