Provider Demographics
NPI:1598141707
Name:STAUNER, MELANIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:STAUNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:395 MELINDA CIR E
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-3455
Mailing Address - Country:US
Mailing Address - Phone:847-421-1580
Mailing Address - Fax:
Practice Address - Street 1:6625 DALY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3410
Practice Address - Country:US
Practice Address - Phone:248-737-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013455235Z00000X
MI7101005914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist