Provider Demographics
NPI:1932484870
Name:BOBNICK, MELINDA LEA (MSED,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:LEA
Last Name:BOBNICK
Suffix:
Gender:F
Credentials:MSED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6806
Mailing Address - Country:US
Mailing Address - Phone:845-838-0975
Mailing Address - Fax:
Practice Address - Street 1:21 SMITH CLOVE RD
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3644
Practice Address - Country:US
Practice Address - Phone:845-460-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015656-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist