Provider Demographics
NPI:1508572181
Name:MELENDEZ, ALYSSA RENAE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RENAE
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 OAK POINT RD APT 201
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2051
Mailing Address - Country:US
Mailing Address - Phone:440-787-4373
Mailing Address - Fax:
Practice Address - Street 1:5355 SAILORWAY DR
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-1500
Practice Address - Country:US
Practice Address - Phone:440-204-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty