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General NPI Number Information
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NPI Number | 1720635915
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Entity Type | Individual
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Provider Name | MIKAYLA MARIE BELLARDINI M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 512 PEACH ST
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City | CROWLEY
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State | TX
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Zip | 76036-3119
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Country | US
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Telephone | 817-297-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 2132 BARBELL LN
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City | FORT WORTH
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State | TX
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Zip | 76111-5017
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Country | US
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Telephone | 727-348-5444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6654
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 117146
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License Number State | TX
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