Individual
MR. BERNARD VINCENT MICELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-SLP
Contact information
Practice address
17273 STATE ROUTE 104, CHILLICOTHE VA MEDICAL CENTER, CHILLICOTHE, OH 45601-0999
(740) 773-1141
(740) 772-7144
Mailing address
57 PERRINE ST, DAYTON, OH 45410-1236
(937) 222-0279
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8283
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00906123
ASHA
—
01
—
8283
STATE LICENSE
OH
Enumeration date
07/24/2006
Last updated
07/08/2007
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