Provider Demographics
NPI:1669679817
Name:HORNER, MELISSA MARY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:MARY
Last Name:HORNER
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Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:6135 CHASEWOOD PKWY APT 304
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-4382
Mailing Address - Country:US
Mailing Address - Phone:952-403-3946
Mailing Address - Fax:952-403-3979
Practice Address - Street 1:1661 PARK RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2841
Practice Address - Country:US
Practice Address - Phone:952-403-3980
Practice Address - Fax:952-403-3979
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN7782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist