Provider Demographics
NPI:1538670526
Name:BORNSTEIN, MELISSA (MS CCC-SLP, MHA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:MS CCC-SLP, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3345
Mailing Address - Country:US
Mailing Address - Phone:484-240-1238
Mailing Address - Fax:
Practice Address - Street 1:821 SPRING GARDEN ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3345
Practice Address - Country:US
Practice Address - Phone:484-240-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist