Provider Demographics
NPI:1558525287
Name:LATHEN-BENNETT, MELISSA A (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:LATHEN-BENNETT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 NE 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1330
Mailing Address - Country:US
Mailing Address - Phone:503-666-5600
Mailing Address - Fax:
Practice Address - Street 1:6325 NE 45TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1330
Practice Address - Country:US
Practice Address - Phone:503-666-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist