Provider Demographics
NPI:1407624851
Name:STORY, MELISSA DEANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DEANNE
Last Name:STORY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DEANNE
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1104 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3254
Mailing Address - Country:US
Mailing Address - Phone:423-384-8787
Mailing Address - Fax:
Practice Address - Street 1:2315 SILVERDALE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2162
Practice Address - Country:US
Practice Address - Phone:423-434-5130
Practice Address - Fax:423-434-5149
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist