Provider Demographics
NPI:1124216726
Name:DRANE, MELISSA (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DRANE
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 LAKEFIELD DR
Mailing Address - Street 2:BLDG. TWO, SUITE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4425
Mailing Address - Country:US
Mailing Address - Phone:678-699-5558
Mailing Address - Fax:
Practice Address - Street 1:11330 LAKEFIELD DR
Practice Address - Street 2:BLDG. TWO, SUITE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4425
Practice Address - Country:US
Practice Address - Phone:678-699-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA281156622BMedicaid