Provider Demographics
NPI:1710003900
Name:MELVIN, JEANNE LYNN (MS)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:LYNN
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5019
Mailing Address - Country:US
Mailing Address - Phone:310-306-4247
Mailing Address - Fax:310-306-3903
Practice Address - Street 1:2458 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-5019
Practice Address - Country:US
Practice Address - Phone:310-306-4247
Practice Address - Fax:310-306-3903
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3809235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT3809Medicare ID - Type UnspecifiedPROVIDER ID NUMBER