Provider Demographics
NPI:1245690395
Name:DEMUTH, MELISSA (BS, SLP-A)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DEMUTH
Suffix:
Gender:F
Credentials:BS, SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44071 FESTIVO ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3958
Mailing Address - Country:US
Mailing Address - Phone:785-320-1166
Mailing Address - Fax:
Practice Address - Street 1:29377 RANCHO CALIFORNIA RD
Practice Address - Street 2:STE 102
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5289
Practice Address - Country:US
Practice Address - Phone:951-595-4673
Practice Address - Fax:951-595-4301
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA 35572355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant