Provider Demographics
NPI:1003154493
Name:REYNOLDS, MELISSA GORDON (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GORDON
Last Name:REYNOLDS
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 1:632 CHERRY LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5628
Mailing Address - Country:US
Mailing Address - Phone:256-553-9882
Mailing Address - Fax:
Practice Address - Street 1:3224 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35906-6202
Practice Address - Country:US
Practice Address - Phone:256-553-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-20
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist