Provider Demographics
NPI:1629355573
Name:DEMIGUEL, MELISSA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DEMIGUEL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 S ALMA SCHOOL RD
Mailing Address - Street 2:STE 145
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3049
Mailing Address - Country:US
Mailing Address - Phone:480-567-6717
Mailing Address - Fax:
Practice Address - Street 1:1745 S ALMA SCHOOL RD
Practice Address - Street 2:STE 145
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3049
Practice Address - Country:US
Practice Address - Phone:602-393-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP7413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist