Provider Demographics
NPI:1326253519
Name:HOLCOMBE, MELANIE CHRISTINE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:CHRISTINE
Last Name:HOLCOMBE
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 1:9534 PINE COVE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4121
Mailing Address - Country:US
Mailing Address - Phone:318-230-1006
Mailing Address - Fax:
Practice Address - Street 1:9534 PINE COVE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-4121
Practice Address - Country:US
Practice Address - Phone:318-230-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1-47342-1Medicaid