Provider Demographics
NPI:1407269954
Name:SANDERS, MELISSA ANN (HIS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 STATE ROAD 35
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:WI
Mailing Address - Zip Code:54025-7424
Mailing Address - Country:US
Mailing Address - Phone:612-400-5055
Mailing Address - Fax:
Practice Address - Street 1:217 VINE ST
Practice Address - Street 2:# 205
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016
Practice Address - Country:US
Practice Address - Phone:715-245-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2775237700000X
WI1425-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist