Provider Demographics
NPI:1568493740
Name:BARRY, MELISSA LYNN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:BARRY
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 1:11769 VIA LUCERNA CIR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6080
Mailing Address - Country:US
Mailing Address - Phone:321-438-7260
Mailing Address - Fax:407-905-8958
Practice Address - Street 1:1002 S DILLARD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-905-8908
Practice Address - Fax:407-905-9858
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist