Provider Demographics
NPI:1619150604
Name:CORELLA, MELISSA ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:CORELLA
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 1:2314 W IVANHOE ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3481
Mailing Address - Country:US
Mailing Address - Phone:480-786-9770
Mailing Address - Fax:
Practice Address - Street 1:793 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE D4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3681
Practice Address - Country:US
Practice Address - Phone:480-626-4142
Practice Address - Fax:480-626-7370
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5730235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist