Provider Demographics
NPI:1821445982
Name:RACKLEY, MELINDA ROBERSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ROBERSON
Last Name:RACKLEY
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 1:1210 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1817
Mailing Address - Country:US
Mailing Address - Phone:252-462-0070
Mailing Address - Fax:252-462-0673
Practice Address - Street 1:1210 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1817
Practice Address - Country:US
Practice Address - Phone:252-462-0070
Practice Address - Fax:252-462-0673
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist