Provider Demographics
NPI:1629490578
Name:PURYEAR, MELISSA ANDERSON (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANDERSON
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4174 RODGERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:VA
Mailing Address - Zip Code:24534-3208
Mailing Address - Country:US
Mailing Address - Phone:434-579-3312
Mailing Address - Fax:
Practice Address - Street 1:4174 RODGERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:VA
Practice Address - Zip Code:24534
Practice Address - Country:US
Practice Address - Phone:434-579-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
VA2202006034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist