Provider Demographics
NPI:1639697014
Name:JOHNSON, MELISSA KAY (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HILLVIEW DR APT 2
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1238
Mailing Address - Country:US
Mailing Address - Phone:330-858-5564
Mailing Address - Fax:
Practice Address - Street 1:150 HALL AVE
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-2075
Practice Address - Country:US
Practice Address - Phone:330-534-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2017526-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist