Provider Demographics
NPI:1477847366
Name:GARDINER, MELISSA ANN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:GARDINER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:PONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 CANFIELD AVENUE
Mailing Address - Street 2:APARTMENT 832
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-3462
Mailing Address - Country:US
Mailing Address - Phone:315-868-1965
Mailing Address - Fax:914-831-1940
Practice Address - Street 1:2 CANFIELD AVE
Practice Address - Street 2:APT 832
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2046
Practice Address - Country:US
Practice Address - Phone:315-858-1965
Practice Address - Fax:914-831-1940
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist