Provider Demographics
NPI:1285008334
Name:BERTAO, MELISSA LANAE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LANAE
Last Name:BERTAO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LANAE
Other - Last Name:POELSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:3066 PORTALS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9380
Mailing Address - Country:US
Mailing Address - Phone:559-779-6390
Mailing Address - Fax:
Practice Address - Street 1:3066 PORTALS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-9380
Practice Address - Country:US
Practice Address - Phone:559-545-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist