Provider Demographics
NPI:1386676179
Name:KIBLER, MELINDA ANN (MS/CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ANN
Last Name:KIBLER
Suffix:
Gender:F
Credentials:MS/CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 W 8TH ST
Mailing Address - Street 2:#200
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-5007
Mailing Address - Country:US
Mailing Address - Phone:814-864-9994
Mailing Address - Fax:814-866-2655
Practice Address - Street 1:1645 W 8TH ST
Practice Address - Street 2:#200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-5007
Practice Address - Country:US
Practice Address - Phone:814-864-9994
Practice Address - Fax:814-866-2655
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000431L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA201958KYFMedicare PIN