Provider Demographics
NPI:1972994630
Name:CALLOUGH, MELANEE
Entity Type:Individual
Prefix:
First Name:MELANEE
Middle Name:
Last Name:CALLOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 S HOLLY CIR
Mailing Address - Street 2:290
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1019
Mailing Address - Country:US
Mailing Address - Phone:720-542-8737
Mailing Address - Fax:720-242-8085
Practice Address - Street 1:6851 S HOLLY CIR
Practice Address - Street 2:290
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1019
Practice Address - Country:US
Practice Address - Phone:720-542-8737
Practice Address - Fax:720-242-8085
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist