Provider Demographics
NPI:1417225467
Name:COLON, MELISSA R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:R
Last Name:COLON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CHURCH ST.
Mailing Address - Street 2:PIETER B. COEYMANS ELEMENTARY SCHOOL
Mailing Address - City:COEYMANS
Mailing Address - State:NY
Mailing Address - Zip Code:12045-0887
Mailing Address - Country:US
Mailing Address - Phone:518-756-5200
Mailing Address - Fax:
Practice Address - Street 1:102 HARRY HOWARD AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1605
Practice Address - Country:US
Practice Address - Phone:518-828-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist