Provider Demographics
NPI:1710239199
Name:MARCI MELZER - SLP
Entity Type:Organization
Organization Name:MARCI MELZER - SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:MELZER
Authorized Official - Suffix:
Authorized Official - Credentials:MED,CCC/SLP
Authorized Official - Phone:850-303-4088
Mailing Address - Street 1:6615 ANCHOR LOOP
Mailing Address - Street 2:APT 204
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-4427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6615 ANCHOR LOOP
Practice Address - Street 2:APT 204
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-4427
Practice Address - Country:US
Practice Address - Phone:850-303-4088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890620300Medicaid