Provider Demographics
NPI:1003151895
Name:CLASS, MELISSA C (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:C
Last Name:CLASS
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 1:22595 RAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6860
Mailing Address - Country:US
Mailing Address - Phone:610-763-1212
Mailing Address - Fax:
Practice Address - Street 1:17026 CADBURY CIR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-7022
Practice Address - Country:US
Practice Address - Phone:610-763-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE04-0000320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist