Provider Demographics
NPI:1558605972
Name:EPPERSON, MELISSA ANN (SLP, CCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25368 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:LOS MOLINOS
Mailing Address - State:CA
Mailing Address - Zip Code:96055-0623
Mailing Address - Country:US
Mailing Address - Phone:530-526-3620
Mailing Address - Fax:
Practice Address - Street 1:320 N CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2326
Practice Address - Country:US
Practice Address - Phone:530-934-2834
Practice Address - Fax:530-934-4624
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 11332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist