Provider Demographics
NPI:1003580127
Name:SMITH, MELISSA JOHNSON (MS, SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOHNSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W KAMILCHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-2206
Mailing Address - Country:US
Mailing Address - Phone:360-999-9971
Mailing Address - Fax:
Practice Address - Street 1:611 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCCLEARY
Practice Address - State:WA
Practice Address - Zip Code:98557-9524
Practice Address - Country:US
Practice Address - Phone:360-495-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist