Provider Demographics
NPI:1760662522
Name:FISKE, MELISSA JULIE (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JULIE
Last Name:FISKE
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BOSTON POST RD E
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3527
Mailing Address - Country:US
Mailing Address - Phone:508-624-0304
Mailing Address - Fax:508-624-0391
Practice Address - Street 1:221 BOSTON POST RD E
Practice Address - Street 2:SUITE 150
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3527
Practice Address - Country:US
Practice Address - Phone:508-624-0304
Practice Address - Fax:508-624-0391
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist