Provider Demographics
NPI:1023373727
Name:STEWART, MELISSA JO (MSCCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JO
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 KINNEYS RD
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:TN
Mailing Address - Zip Code:37010-5021
Mailing Address - Country:US
Mailing Address - Phone:931-624-9690
Mailing Address - Fax:
Practice Address - Street 1:2002 GREER RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-7166
Practice Address - Country:US
Practice Address - Phone:615-859-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist