Provider Demographics
NPI:1043575434
Name:MELVIN, AMY LYNN (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:MELVIN
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 1:320 S BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4237
Mailing Address - Country:US
Mailing Address - Phone:308-930-0153
Mailing Address - Fax:
Practice Address - Street 1:1220 W 2ND ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3652
Practice Address - Country:US
Practice Address - Phone:308-930-0153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist