Provider Demographics
NPI:1093187478
Name:BELLMORE, AUSTIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:BELLMORE
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 1:8660 SPRING MOUNTAIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4101
Mailing Address - Country:US
Mailing Address - Phone:702-462-5252
Mailing Address - Fax:702-685-5009
Practice Address - Street 1:8660 SPRING MOUNTAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4101
Practice Address - Country:US
Practice Address - Phone:702-462-5252
Practice Address - Fax:702-685-5009
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008038235Z00000X
NVSP-2145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist