Provider Demographics
NPI:1538385901
Name:GOENS, MICHEA BELLEMEUR (MSED,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHEA
Middle Name:BELLEMEUR
Last Name:GOENS
Suffix:
Gender:F
Credentials:MSED,CCC-SLP
Other - Prefix:MISS
Other - First Name:MICHEA
Other - Middle Name:LYNN
Other - Last Name:BELLEMEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3619 CAMPUS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1313
Mailing Address - Country:US
Mailing Address - Phone:505-400-8218
Mailing Address - Fax:
Practice Address - Street 1:3619 CAMPUS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1313
Practice Address - Country:US
Practice Address - Phone:505-400-8218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003227235Z00000X
NM4671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist