Healthcare Provider Details

I. General information

NPI: 1992484240
Provider Name (Legal Business Name): MICHAELA REICHERT - BUGUMBA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA REICHERT

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 GREENBRIAR DR
SOUTHLAKE TX
76092-8355
US

IV. Provider business mailing address

1735 WINDCREST LN
AURORA IL
60504-4719
US

V. Phone/Fax

Practice location:
  • Phone: 817-442-9022
  • Fax:
Mailing address:
  • Phone: 773-987-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.016805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: