Provider Demographics
NPI:1326597352
Name:BARRERA, MELISSA CRYSTAL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CRYSTAL
Last Name:BARRERA
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 1:3381 MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6395
Mailing Address - Country:US
Mailing Address - Phone:956-465-7711
Mailing Address - Fax:
Practice Address - Street 1:1273 NORTHFIELD DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6184
Practice Address - Country:US
Practice Address - Phone:931-919-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist