Provider Demographics
NPI:1609160803
Name:STEWART, MELISSA W (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:W
Last Name:STEWART
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:W
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:322 S BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2632
Mailing Address - Country:US
Mailing Address - Phone:502-893-0159
Mailing Address - Fax:502-213-3843
Practice Address - Street 1:4004 DUPONT CIRCLE
Practice Address - Street 2:SUITE 220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-4761
Practice Address - Country:US
Practice Address - Phone:502-893-0159
Practice Address - Fax:502-213-3843
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2355235Z00000X
IN22005277A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist