Provider Demographics
NPI:1285829218
Name:VUKICH, MELISSA DAWN (MS)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:DAWN
Last Name:VUKICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:100 PUSHROOT CT.
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3460
Mailing Address - Country:US
Mailing Address - Phone:307-856-4337
Mailing Address - Fax:307-856-0851
Practice Address - Street 1:558 EAST 2ND ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435
Practice Address - Country:US
Practice Address - Phone:307-754-2231
Practice Address - Fax:307-754-9829
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1770688871Medicaid