Provider Demographics
NPI:1407974272
Name:THEIS, MELANIE R (MED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:R
Last Name:THEIS
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15236 DUPONT CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5859
Mailing Address - Country:US
Mailing Address - Phone:952-235-2571
Mailing Address - Fax:952-235-2577
Practice Address - Street 1:14650 GARRETT AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7543
Practice Address - Country:US
Practice Address - Phone:952-236-2571
Practice Address - Fax:952-236-2571
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist