1952311649 NPI number — CHRISTI MICHELLE BACON SLP

Table of content: CHRISTI MICHELLE BACON SLP (NPI 1952311649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952311649 NPI number — CHRISTI MICHELLE BACON SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BACON
Provider First Name:
CHRISTI
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952311649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 E MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
APT. 1803
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77598-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-829-0687
Provider Business Mailing Address Fax Number:
281-485-4818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8619 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-8782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-485-4818
Provider Business Practice Location Address Fax Number:
281-485-5446
Provider Enumeration Date:
08/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  24319 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)