Provider Demographics
NPI:1437408457
Name:MORRISON, MELISSA KIM (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KIM
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KIM
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1415 RIDGEBACK RD STE 21
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6984
Mailing Address - Country:US
Mailing Address - Phone:619-207-0984
Mailing Address - Fax:
Practice Address - Street 1:1415 RIDGEBACK RD STE 21
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6984
Practice Address - Country:US
Practice Address - Phone:619-207-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP20914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist