Provider Demographics
NPI:1437399839
Name:LIEVANO-GOMES, MELISSA A (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:LIEVANO-GOMES
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 BLACK LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4658
Mailing Address - Country:US
Mailing Address - Phone:407-654-5048
Mailing Address - Fax:
Practice Address - Street 1:790 6TH ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4013
Practice Address - Country:US
Practice Address - Phone:863-229-8319
Practice Address - Fax:863-229-8492
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist