Provider Demographics
NPI:1528563061
Name:VENABLE, MIKELLE (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MIKELLE
Middle Name:
Last Name:VENABLE
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3940
Mailing Address - Country:US
Mailing Address - Phone:757-888-3200
Mailing Address - Fax:
Practice Address - Street 1:929 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23604-1105
Practice Address - Country:US
Practice Address - Phone:757-888-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist