Provider Demographics
NPI:1215182290
Name:MEDLIN, MELANIE RENEE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:RENEE
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SHERRIL LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6846
Mailing Address - Country:US
Mailing Address - Phone:909-792-9129
Mailing Address - Fax:
Practice Address - Street 1:27 SHERRIL LN
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6846
Practice Address - Country:US
Practice Address - Phone:909-792-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist