Individual
MRS. MICHELLE CAROL SOUTHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
RR 1 BOX 34 A, AUGUSTA, WV 26704-9706
(304) 496-8284
(304) 496-9761
Mailing address
RR 1 BOX 34 A, AUGUSTA, WV 26704-9706
(304) 496-8284
(304) 496-9761
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
394
WV
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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