Provider Demographics
NPI:1477070175
Name:SCHUCKMAN, MELANIE (MA-CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SCHUCKMAN
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 1:516 PRYTANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2911
Mailing Address - Country:US
Mailing Address - Phone:513-313-6319
Mailing Address - Fax:
Practice Address - Street 1:1324 MIDDLETOWN EATON RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1525
Practice Address - Country:US
Practice Address - Phone:513-420-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist