Provider Demographics
NPI:1346556503
Name:RONGO, MELANIE SUE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:SUE
Last Name:RONGO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-2562
Mailing Address - Country:US
Mailing Address - Phone:716-439-0793
Mailing Address - Fax:
Practice Address - Street 1:629 MARKET ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-2562
Practice Address - Country:US
Practice Address - Phone:716-439-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009575-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist