Provider Demographics
NPI:1659889582
Name:MELZER, KELLY ANNE (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:MELZER
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6617
Mailing Address - Country:US
Mailing Address - Phone:847-962-4043
Mailing Address - Fax:
Practice Address - Street 1:1225 GREENBRIAR LN
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4522
Practice Address - Country:US
Practice Address - Phone:847-504-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist