Provider Demographics
NPI:1003017799
Name:VANDERPOL, MELANIE (AUD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:VANDERPOL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-302-1000
Mailing Address - Fax:208-302-1035
Practice Address - Street 1:6094 W EMERALD STREET
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8855
Practice Address - Country:US
Practice Address - Phone:208-302-1000
Practice Address - Fax:208-302-1035
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-3852231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist