Provider Demographics
NPI:1063671626
Name:CANTRELL, MELODIE SUE (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:SUE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3232
Mailing Address - Country:US
Mailing Address - Phone:405-625-6415
Mailing Address - Fax:
Practice Address - Street 1:2506 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-3232
Practice Address - Country:US
Practice Address - Phone:405-625-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist