Provider Demographics
NPI:1235575994
Name:MCCLUNG, MELISSA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:MCCLUNG
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 1:8002 KEW GARDENS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3609
Mailing Address - Country:US
Mailing Address - Phone:718-793-2183
Mailing Address - Fax:
Practice Address - Street 1:175 REMSEN ST.
Practice Address - Street 2:4TH FLOOR, SUITE 1201
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:212-273-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20167235Z00000X
NY022559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist