Provider Demographics
NPI:1679088439
Name:PACHECO, MELANIE LIRA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:LIRA
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WELLMORE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9172
Mailing Address - Country:US
Mailing Address - Phone:803-520-1200
Mailing Address - Fax:
Practice Address - Street 1:200 WELLMORE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9172
Practice Address - Country:US
Practice Address - Phone:803-520-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-02
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist