Provider Demographics
NPI:1891161709
Name:FLIES, MELISSA K (SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:FLIES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:K
Other - Last Name:JANVRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-1821
Mailing Address - Country:US
Mailing Address - Phone:815-943-5431
Mailing Address - Fax:815-943-0659
Practice Address - Street 1:901 GRANT ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-1821
Practice Address - Country:US
Practice Address - Phone:815-943-5431
Practice Address - Fax:815-943-0659
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-007040235Z00000X
WI4170-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist