Provider Demographics
NPI:1871840132
Name:BACON, MELISSA M
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:BACON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 BEE CREEK RD
Mailing Address - Street 2:SPECIAL SERVICES -- CLAIM CARE
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9395
Mailing Address - Country:US
Mailing Address - Phone:417-334-6541
Mailing Address - Fax:417-334-6619
Practice Address - Street 1:1756 BEE CREEK RD
Practice Address - Street 2:SPECIAL SERVICES -- CLAIM CARE
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9395
Practice Address - Country:US
Practice Address - Phone:417-334-6541
Practice Address - Fax:417-334-6619
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005016209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist