Provider Demographics
NPI:1679831895
Name:BELL, MELISSA SUE (MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SUE
Last Name:BELL
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:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:VIRGIE
Mailing Address - State:KY
Mailing Address - Zip Code:41572-0095
Mailing Address - Country:US
Mailing Address - Phone:606-639-0471
Mailing Address - Fax:
Practice Address - Street 1:939 HIGHWAY 610 WEST
Practice Address - Street 2:
Practice Address - City:VIRGIE
Practice Address - State:KY
Practice Address - Zip Code:41572
Practice Address - Country:US
Practice Address - Phone:606-639-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3130235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGN-996Medicaid