Provider Demographics
NPI:1952643173
Name:MELROSE, MELISSA ABIGAIL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ABIGAIL
Last Name:MELROSE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 LONGWELL PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1199
Mailing Address - Country:US
Mailing Address - Phone:317-514-5007
Mailing Address - Fax:
Practice Address - Street 1:1042 LONGWELL PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1199
Practice Address - Country:US
Practice Address - Phone:317-514-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005420A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist