Provider Demographics
NPI:1275124471
Name:KEPPER, MELISSA LEAH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEAH
Last Name:KEPPER
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 1:4004 LAMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7634
Mailing Address - Country:US
Mailing Address - Phone:704-307-3150
Mailing Address - Fax:
Practice Address - Street 1:8848 RED OAK BLVD STE AA
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-5595
Practice Address - Country:US
Practice Address - Phone:980-422-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist