Provider Demographics
NPI:1982038865
Name:LEGENDRE, MELISSA (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:LEGENDRE
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 CANYON STONE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3954
Mailing Address - Country:US
Mailing Address - Phone:305-801-7549
Mailing Address - Fax:
Practice Address - Street 1:1600 TOWN PLAZA CT STE 1612
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6210
Practice Address - Country:US
Practice Address - Phone:407-580-8500
Practice Address - Fax:321-281-4942
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist