Provider Demographics
NPI:1437376407
Name:VOLLER, MELISSA (MA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VOLLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 KENSINGTON AVE # A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5629
Mailing Address - Country:US
Mailing Address - Phone:406-880-3468
Mailing Address - Fax:
Practice Address - Street 1:904 KENSINGTON AVE # A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5629
Practice Address - Country:US
Practice Address - Phone:406-880-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSP1075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist