Provider Demographics
NPI:1952664138
Name:WEISSER, MELISSA ROBIN (AUD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ROBIN
Last Name:WEISSER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:ROBIN
Other - Last Name:NIELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1515 MAIN ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2864
Mailing Address - Country:US
Mailing Address - Phone:303-776-8748
Mailing Address - Fax:303-684-9915
Practice Address - Street 1:1515 MAIN ST
Practice Address - Street 2:SUITE 15
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2864
Practice Address - Country:US
Practice Address - Phone:303-776-8748
Practice Address - Fax:303-684-9915
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO648231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist