Provider Demographics
NPI:1891199238
Name:WHITE, MELANIE (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 GETWELL RD STE 212D
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7320
Mailing Address - Country:US
Mailing Address - Phone:662-895-6455
Mailing Address - Fax:662-895-6460
Practice Address - Street 1:5960 GETWELL RD STE 212D
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7320
Practice Address - Country:US
Practice Address - Phone:662-895-6455
Practice Address - Fax:662-895-6460
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3466231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist