Provider Demographics
NPI:1568432813
Name:MELZER, MARCIA B (M,ED,CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:B
Last Name:MELZER
Suffix:
Gender:F
Credentials:M,ED,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3930
Mailing Address - Country:US
Mailing Address - Phone:850-303-4088
Mailing Address - Fax:850-248-9905
Practice Address - Street 1:1419 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3930
Practice Address - Country:US
Practice Address - Phone:850-303-4088
Practice Address - Fax:850-248-9905
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist