Provider Demographics
NPI:1497883235
Name:PETRICH, MELINDA PETERS (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:PETERS
Last Name:PETRICH
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 CRAIGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1702
Mailing Address - Country:US
Mailing Address - Phone:412-276-6865
Mailing Address - Fax:412-276-6865
Practice Address - Street 1:3394 SAXONBURG BLVD
Practice Address - Street 2:SUITE 620
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-3168
Practice Address - Country:US
Practice Address - Phone:412-767-5967
Practice Address - Fax:412-767-5960
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101638115Medicaid