Provider Demographics
NPI:1003059171
Name:WOODY, MELISSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WOODY
Suffix:
Gender:F
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 1:1681 S LOGAN PASS
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7914
Mailing Address - Country:US
Mailing Address - Phone:316-519-0596
Mailing Address - Fax:
Practice Address - Street 1:1681 S LOGAN PASS
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-7914
Practice Address - Country:US
Practice Address - Phone:316-519-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2462235Z00000X
KS235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist