Provider Demographics
NPI:1023395068
Name:REHWALDT, MELINDA AUSTIN (MA)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:AUSTIN
Last Name:REHWALDT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:NY
Mailing Address - Zip Code:14058-9518
Mailing Address - Country:US
Mailing Address - Phone:585-757-9967
Mailing Address - Fax:
Practice Address - Street 1:57 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:NY
Practice Address - Zip Code:14058
Practice Address - Country:US
Practice Address - Phone:585-757-9967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58010847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist