Provider Demographics
NPI:1184874000
Name:BYRUM, MELISSA LUCILLE (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LUCILLE
Last Name:BYRUM
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5367
Mailing Address - Country:US
Mailing Address - Phone:405-641-3534
Mailing Address - Fax:918-423-2353
Practice Address - Street 1:407 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5367
Practice Address - Country:US
Practice Address - Phone:405-641-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-28
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3120235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist