Provider Demographics
NPI:1801395900
Name:REYNOLDS, MELANIE DAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAWN
Last Name:REYNOLDS
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 1:138 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7536
Mailing Address - Country:US
Mailing Address - Phone:214-679-0235
Mailing Address - Fax:
Practice Address - Street 1:138 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7536
Practice Address - Country:US
Practice Address - Phone:214-679-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty