Healthcare Provider Details

I. General information

NPI: 1164947594
Provider Name (Legal Business Name): MICHELLE BELLEVILLE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 PIERCY RD
SAN JOSE CA
95138-1403
US

IV. Provider business mailing address

367 SANTANA HTS UNIT 7039
SAN JOSE CA
95128-2084
US

V. Phone/Fax

Practice location:
  • Phone: 408-692-5197
  • Fax: 408-912-2645
Mailing address:
  • Phone: 847-902-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.013907
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: