Provider Demographics
NPI:1174016703
Name:CROOKSTON, MELANIE LEIGH
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LEIGH
Last Name:CROOKSTON
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 1:3105 CALL RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2107
Mailing Address - Country:US
Mailing Address - Phone:330-676-0747
Mailing Address - Fax:
Practice Address - Street 1:1128 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-9577
Practice Address - Country:US
Practice Address - Phone:330-552-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.5635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist