Provider Demographics
NPI:1952311649
Name:BACON, CHRISTI MICHELLE (SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:MICHELLE
Last Name:BACON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E MEDICAL CENTER BLVD
Mailing Address - Street 2:APT. 1803
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4346
Mailing Address - Country:US
Mailing Address - Phone:713-829-0687
Mailing Address - Fax:281-485-4818
Practice Address - Street 1:8619 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8782
Practice Address - Country:US
Practice Address - Phone:281-485-4818
Practice Address - Fax:281-485-5446
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist