Provider Demographics
NPI:1609393222
Name:CUTSHAW, MELISSA (SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CUTSHAW
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 S SUGAR ST
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47220-2066
Practice Address - Country:US
Practice Address - Phone:812-358-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY141178235Z00000X
IN22006222A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist