Provider Demographics
NPI:1790120582
Name:HAMILTON, MELISSA JEAN (MA, CCC SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:HAMILTON
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 1:484 RED SAIL WAY
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3733
Mailing Address - Country:US
Mailing Address - Phone:321-698-2886
Mailing Address - Fax:
Practice Address - Street 1:484 RED SAIL WAY
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937
Practice Address - Country:US
Practice Address - Phone:321-698-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00728800235Z00000X
FLSA 14231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM9105OtherMEDICARE HF