Provider Demographics
NPI:1881828515
Name:BELL-BADGER, MICHELE A (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:BELL-BADGER
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 1:2949 THORNCREST DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2252
Mailing Address - Country:US
Mailing Address - Phone:904-333-4679
Mailing Address - Fax:904-356-5484
Practice Address - Street 1:2949 THORNCREST DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-2252
Practice Address - Country:US
Practice Address - Phone:904-333-4679
Practice Address - Fax:904-356-5484
Is Sole Proprietor?:No
Enumeration Date:2009-05-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist