Provider Demographics
NPI:1548282635
Name:MICELI, BERNARD VINCENT (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:VINCENT
Last Name:MICELI
Suffix:
Gender:M
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 1:57 PERRINE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1236
Mailing Address - Country:US
Mailing Address - Phone:937-222-0279
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:CHILLICOTHE VA MEDICAL CENTER
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-0999
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:740-772-7144
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00906123OtherASHA
OH8283OtherSTATE LICENSE