Provider Demographics
NPI:1083840334
Name:MELANIE E. CANADA
Entity Type:Organization
Organization Name:MELANIE E. CANADA
Other - Org Name:SMALL TALK SPEECH & THERAPY CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CANADA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:434-481-3524
Mailing Address - Street 1:69 DEANE RD
Mailing Address - Street 2:
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3482
Mailing Address - Country:US
Mailing Address - Phone:434-481-3524
Mailing Address - Fax:434-481-3628
Practice Address - Street 1:69 DEANE RD
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3482
Practice Address - Country:US
Practice Address - Phone:434-481-3524
Practice Address - Fax:434-481-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083840334Medicaid