Provider Demographics
NPI:1598008021
Name:GRIFFIN, MELISSA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GRIFFIN
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 1:4825 BAY HERON PL
Mailing Address - Street 2:APT. 522
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-2943
Mailing Address - Country:US
Mailing Address - Phone:231-557-8750
Mailing Address - Fax:
Practice Address - Street 1:4825 BAY HERON PL
Practice Address - Street 2:APT. 522
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-2943
Practice Address - Country:US
Practice Address - Phone:231-557-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 11117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist