Provider Demographics
NPI:1790109973
Name:HEIST, MELANIE (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:HEIST
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1917
Mailing Address - Country:US
Mailing Address - Phone:330-580-3502
Mailing Address - Fax:330-580-3165
Practice Address - Street 1:2823 9TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1917
Practice Address - Country:US
Practice Address - Phone:330-580-3502
Practice Address - Fax:330-580-3165
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.5476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist