Healthcare Provider Details

I. General information

NPI: 1134871429
Provider Name (Legal Business Name): MICHELLE BABIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 10/18/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12429 SCOFIELD FARMS DR
AUSTIN TX
78758-2640
US

IV. Provider business mailing address

1500 E RIVERSIDE DR APT 612
AUSTIN TX
78741-1190
US

V. Phone/Fax

Practice location:
  • Phone: 512-835-9080
  • Fax:
Mailing address:
  • Phone: 203-610-7976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number005706
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number120128
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: