Provider Demographics
NPI:1053455634
Name:MELANIE O'ROURKE SPEECH SERVICES, LLC
Entity Type:Organization
Organization Name:MELANIE O'ROURKE SPEECH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-882-5554
Mailing Address - Street 1:6350 W LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1004
Mailing Address - Country:US
Mailing Address - Phone:623-882-5554
Mailing Address - Fax:
Practice Address - Street 1:6350 W LARIAT LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-1004
Practice Address - Country:US
Practice Address - Phone:623-882-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP4867OtherSLP LICENSE