Provider Demographics
NPI:1205104940
Name:STILLS, MELODY K (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MELODY
Middle Name:K
Last Name:STILLS
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:P.O. BOX 1288
Mailing Address - Street 2:580 FARRINGDOM STREET
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359
Mailing Address - Country:US
Mailing Address - Phone:910-610-7821
Mailing Address - Fax:
Practice Address - Street 1:714 ATKINSON STREET
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352
Practice Address - Country:US
Practice Address - Phone:910-423-5622
Practice Address - Fax:910-423-5538
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist