Provider Demographics
NPI:1215553060
Name:MCNUTT, MELISSA (CCC SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2620
Mailing Address - Country:US
Mailing Address - Phone:760-519-7683
Mailing Address - Fax:
Practice Address - Street 1:1957 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2620
Practice Address - Country:US
Practice Address - Phone:760-519-7683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist