Provider Demographics
NPI:1730467358
Name:NEWELL-SHEPHERD, MELISSA LYNN (SLP/CCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:NEWELL-SHEPHERD
Suffix:
Gender:F
Credentials:SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 S LINDBERGH BLVD
Mailing Address - Street 2:STE. 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7040
Mailing Address - Country:US
Mailing Address - Phone:314-845-7751
Mailing Address - Fax:314-845-7752
Practice Address - Street 1:6022 S LINDBERGH BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7040
Practice Address - Country:US
Practice Address - Phone:314-845-7751
Practice Address - Fax:314-845-7752
Is Sole Proprietor?:No
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004017839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist