Provider Demographics
NPI:1205038338
Name:BRANAM, MELISSA S (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:BRANAM
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 LANGHAM CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4114
Mailing Address - Country:US
Mailing Address - Phone:317-573-4370
Mailing Address - Fax:
Practice Address - Street 1:11770 LANGHAM CRESCENT CT
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-4114
Practice Address - Country:US
Practice Address - Phone:317-573-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002304A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200544400Medicaid