Provider Demographics
NPI:1437495330
Name:MCDONOUGH, MELISSA KAY (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:KAY
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 HILLSBORO RD
Mailing Address - Street 2:APT. 23
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1638
Mailing Address - Country:US
Mailing Address - Phone:618-559-7019
Mailing Address - Fax:
Practice Address - Street 1:500 CAYCE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2910
Practice Address - Country:US
Practice Address - Phone:573-756-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009018159235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist