Provider Demographics
NPI:1508816125
Name:BELL-MILLER, SERENA BUSHNELL (MACCC/SLP)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:BUSHNELL
Last Name:BELL-MILLER
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WESTON WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5717
Mailing Address - Country:US
Mailing Address - Phone:407-325-9776
Mailing Address - Fax:407-294-1497
Practice Address - Street 1:1301 WESTON WOODS BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-5717
Practice Address - Country:US
Practice Address - Phone:407-325-9776
Practice Address - Fax:407-294-1497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist