Organization Name: | BELL TRACE HEALTH & LIVING |
NPI Number: | 1992956536 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEPHEN MOORE (CEO/OWNER) |
Mailing Address: | 725 N Bell Trace Cir Bloomington |
State: | IN US |
Postal Code: | 474084408 |
Phone Number: | 8123232858 |
Fax Number: | 8123232854 |
NPI Enumeration Date: | 10/01/2008 |
NPI Last Update Date: | 10/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 22002301A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |