Provider Demographics
NPI:1023654787
Name:BELL, JACQUELINE MARIE (CCC,SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:BELL
Suffix:
Gender:F
Credentials:CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8027 154TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WYNDMERE
Mailing Address - State:ND
Mailing Address - Zip Code:58081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8027 154TH AVE SE
Practice Address - Street 2:
Practice Address - City:WYNDMERE
Practice Address - State:ND
Practice Address - Zip Code:58081
Practice Address - Country:US
Practice Address - Phone:701-680-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND000428348235Z00000X
ND1807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist