Provider Demographics
NPI:1003210154
Name:BOSTWICK, MELISSA L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:BOSTWICK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4928 KESSLER DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-2770
Mailing Address - Country:US
Mailing Address - Phone:513-621-5712
Mailing Address - Fax:
Practice Address - Street 1:9441 LBJ FWY STE 104
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4637
Practice Address - Country:US
Practice Address - Phone:866-575-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist