Provider Demographics
NPI:1578283396
Name:NEELY, MELODY GRACE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:GRACE
Last Name:NEELY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:LA TOSHIA
Other - Middle Name:BOUVIER
Other - Last Name:NEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:41 FAWN CREEK PASS
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-4502
Mailing Address - Country:US
Mailing Address - Phone:615-569-1095
Mailing Address - Fax:
Practice Address - Street 1:41 FAWN CREEK PASS
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-4502
Practice Address - Country:US
Practice Address - Phone:615-569-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000001847235Z00000X
WALL61222749235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist