Provider Demographics
NPI:1083023295
Name:DERMODY, MEL A (HID)
Entity Type:Individual
Prefix:
First Name:MEL
Middle Name:A
Last Name:DERMODY
Suffix:
Gender:M
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11457 OLDE CABIN RD
Mailing Address - Street 2:SUITE 337
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7139
Mailing Address - Country:US
Mailing Address - Phone:314-888-6653
Mailing Address - Fax:314-888-6662
Practice Address - Street 1:1136 S DELANO CT W STE B201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3734
Practice Address - Country:US
Practice Address - Phone:312-528-3233
Practice Address - Fax:312-264-2334
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3189237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist