Provider Demographics
NPI:1376622795
Name:COPPLE, MELISSA HJELT
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:HJELT
Last Name:COPPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6522
Mailing Address - Country:US
Mailing Address - Phone:760-822-7317
Mailing Address - Fax:
Practice Address - Street 1:2744 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6522
Practice Address - Country:US
Practice Address - Phone:760-822-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist