Provider Demographics
NPI:1144762162
Name:FALL, MELIA (MS CFY/SLP)
Entity Type:Individual
Prefix:MISS
First Name:MELIA
Middle Name:
Last Name:FALL
Suffix:
Gender:F
Credentials:MS CFY/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HILLCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628
Mailing Address - Country:US
Mailing Address - Phone:573-431-3300
Mailing Address - Fax:
Practice Address - Street 1:405 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1421
Practice Address - Country:US
Practice Address - Phone:573-431-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016022747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist