Provider Demographics
NPI:1467601344
Name:SOCHA, MELISSA LEA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEA
Last Name:SOCHA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:LEA
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:2153 SCHOOL LANE
Mailing Address - Street 2:SUAMIRO ELEMENTARY
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313
Mailing Address - Country:US
Mailing Address - Phone:920-662-9806
Mailing Address - Fax:920-662-9808
Practice Address - Street 1:2153 SCHOOL LANE
Practice Address - Street 2:SUAMIRO ELEMENTARY
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313
Practice Address - Country:US
Practice Address - Phone:920-662-9806
Practice Address - Fax:920-662-9808
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2125-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42786800Medicaid