Provider Demographics
NPI:1386034551
Name:JAYJOHN, MELISSA NICOLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:NICOLE
Last Name:JAYJOHN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E PEASE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-1357
Mailing Address - Country:US
Mailing Address - Phone:937-859-5121
Mailing Address - Fax:
Practice Address - Street 1:510 E PEASE AVE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1359
Practice Address - Country:US
Practice Address - Phone:937-859-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND 2014130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist