Provider Demographics
NPI:1144959164
Name:BOVEA, MACHELE L (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MACHELE
Middle Name:L
Last Name:BOVEA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-4413
Mailing Address - Country:US
Mailing Address - Phone:817-308-6550
Mailing Address - Fax:
Practice Address - Street 1:11450 LIBERTY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-5550
Practice Address - Country:US
Practice Address - Phone:817-444-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist