Provider Demographics
NPI:1083759237
Name:BRAISLIN, MELISSA GUISTI (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GUISTI
Last Name:BRAISLIN
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 1:113 UPPER KENT HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-1814
Mailing Address - Country:US
Mailing Address - Phone:860-927-3252
Mailing Address - Fax:
Practice Address - Street 1:113 UPPER KENT HOLLOW RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1814
Practice Address - Country:US
Practice Address - Phone:860-927-3252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003457235Z00000X
NY58-015615235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist