Provider Demographics
NPI:1972020816
Name:SALAS, MELISSA (MS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SALAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-4023
Mailing Address - Country:US
Mailing Address - Phone:575-739-2200
Mailing Address - Fax:
Practice Address - Street 1:1000 E CACTUS LN
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-2840
Practice Address - Country:US
Practice Address - Phone:806-891-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114887235Z00000X
NMC-6241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist