Provider Demographics
NPI:1508110016
Name:MARLEY, MELINDA MARY (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:MARY
Last Name:MARLEY
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W RAND ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-1418
Mailing Address - Country:US
Mailing Address - Phone:315-894-2707
Mailing Address - Fax:
Practice Address - Street 1:118 W RAND ST
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1418
Practice Address - Country:US
Practice Address - Phone:315-894-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000761-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist