Provider Demographics
NPI:1184122897
Name:BRASKETT, MELISSA (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BRASKETT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:604 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4435
Mailing Address - Country:US
Mailing Address - Phone:970-640-9210
Mailing Address - Fax:
Practice Address - Street 1:9414 NE FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6109
Practice Address - Country:US
Practice Address - Phone:970-640-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist