Provider Demographics
NPI:1639646474
Name:HARRIS, MELODY KAY (SLP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:KAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:KAY
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423 BRANDON LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4470
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17051 E HIGHWAY 412
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-8582
Practice Address - Country:US
Practice Address - Phone:479-750-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist