Provider Demographics
NPI:1003930496
Name:HARMER, MELINDA LOUISE (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:LOUISE
Last Name:HARMER
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 1:679 BRISTLECONE DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-736-0331
Mailing Address - Fax:208-734-6795
Practice Address - Street 1:1201 FALLS AVE EAST
Practice Address - Street 2:SUITE 36
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-734-6700
Practice Address - Fax:208-734-6795
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP 1336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDSPB19OtherBLUE CROSS
ID000010024246OtherBLUE SHIELD