Provider Demographics
NPI:1205144698
Name:WHITE, MELISSA A (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:WHITE
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 1:10531 COUNTY ROAD 15B
Mailing Address - Street 2:
Mailing Address - City:CANASERAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14822-9760
Mailing Address - Country:US
Mailing Address - Phone:607-324-0247
Mailing Address - Fax:
Practice Address - Street 1:84 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:CANISTEO
Practice Address - State:NY
Practice Address - Zip Code:14823-1230
Practice Address - Country:US
Practice Address - Phone:607-698-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist