Provider Demographics
NPI:1164564845
Name:ACKLEY, MELINDA L
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:L
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11399 SPRINGVILLE BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST CONCORD
Mailing Address - State:NY
Mailing Address - Zip Code:14055-9711
Mailing Address - Country:US
Mailing Address - Phone:716-592-4247
Mailing Address - Fax:
Practice Address - Street 1:960 MAPLE RD
Practice Address - Street 2:SUBURBAN ADULT SERVICES
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9530
Practice Address - Country:US
Practice Address - Phone:716-805-1555
Practice Address - Fax:716-805-1444
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013362-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist