Provider Demographics
NPI:1598882292
Name:WASKOM, MELANIE MARIE (CCC-SLP)
Entity Type:Individual
Prefix:PROF
First Name:MELANIE
Middle Name:MARIE
Last Name:WASKOM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4615
Mailing Address - Country:US
Mailing Address - Phone:337-898-1686
Mailing Address - Fax:
Practice Address - Street 1:217 WHITE ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4615
Practice Address - Country:US
Practice Address - Phone:337-898-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1841321924OtherCLINIC NPI#
LA4507OtherSPEECH LANG PATH LIC#