Provider Demographics
NPI:1497380398
Name:SMITH, MELLONEE DIXON (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELLONEE
Middle Name:DIXON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PEARMAN DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-3101
Mailing Address - Country:US
Mailing Address - Phone:864-260-5090
Mailing Address - Fax:
Practice Address - Street 1:405 PEARMAN DAIRY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-3101
Practice Address - Country:US
Practice Address - Phone:864-260-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist