Provider Demographics
NPI:1720577794
Name:BELLEGARDE, MILCA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MILCA
Middle Name:
Last Name:BELLEGARDE
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 1:2459 WILKINSON BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5674
Mailing Address - Country:US
Mailing Address - Phone:704-268-9167
Mailing Address - Fax:
Practice Address - Street 1:2459 WILKINSON BLVD STE 310
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5674
Practice Address - Country:US
Practice Address - Phone:704-268-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist