Provider Demographics
NPI:1710315064
Name:FREY, MELINDA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ANN
Last Name:FREY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MIRASOL CIR APT 210
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5145
Mailing Address - Country:US
Mailing Address - Phone:321-480-6979
Mailing Address - Fax:
Practice Address - Street 1:501 MIRASOL CIR APT 210
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5145
Practice Address - Country:US
Practice Address - Phone:321-480-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist