Provider Demographics
NPI:1639406168
Name:PRICE, MELISSA KAITLIN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAITLIN
Last Name:PRICE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAITLIN PRICE
Other - Last Name:RAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:24 PENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7420
Mailing Address - Country:US
Mailing Address - Phone:518-316-0608
Mailing Address - Fax:207-204-0317
Practice Address - Street 1:9 LANDMARK RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8484
Practice Address - Country:US
Practice Address - Phone:072-502-5185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
WYSP-962235Z00000X
MESP2303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist