Provider Demographics
NPI:1497891907
Name:STEPHENS, MELISSA (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:STEPHENS
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 1:2843 COMMUNITY LN
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2337
Mailing Address - Country:US
Mailing Address - Phone:636-677-3473
Mailing Address - Fax:
Practice Address - Street 1:2843 COMMUNITY LN
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2337
Practice Address - Country:US
Practice Address - Phone:636-677-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist