Provider Demographics
NPI:1356441984
Name:JOHNSTON, MELISSA BETH (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:BETH
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 30TH ST
Mailing Address - Street 2:AUDIOLOGY (126)
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5753
Mailing Address - Country:US
Mailing Address - Phone:515-699-5639
Mailing Address - Fax:515-699-5601
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:AUDIOLOGY (126)
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5639
Practice Address - Fax:515-699-5601
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00346231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist