Provider Demographics
NPI:1114067121
Name:KNOWLTON, MELANIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8913
Mailing Address - Country:US
Mailing Address - Phone:501-259-8738
Mailing Address - Fax:
Practice Address - Street 1:PATHFINDER, INC.
Practice Address - Street 2:2615 W. MAIN STREET
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-982-4578
Practice Address - Fax:501-982-1253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP #1870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist