Individual
MRS. MARY CHRISTINE MICHENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC SLP
Contact information
Practice address
1525 ADDISON AVE E STE 6, TWIN FALLS, ID 83301-5383
(208) 420-1316
(208) 733-0120
Mailing address
1175 E 900 S, EDEN, ID 83325-5009
(208) 825-5778
(208) 733-0120
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1400
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010141489
BLUE SHIELD PROVIDER NUMB
ID
01
—
SP656
BLUE CROSS PROVIDER NUMBE
ID
Enumeration date
11/27/2006
Last updated
07/08/2007
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