Provider Demographics
NPI:1255717161
Name:MELENCHICK, MARIA (MA SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:MELENCHICK
Suffix:
Gender:F
Credentials:MA SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 MIFFLIN ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3045
Mailing Address - Country:US
Mailing Address - Phone:570-691-6222
Mailing Address - Fax:
Practice Address - Street 1:1618 MIFFLIN ST
Practice Address - Street 2:APT 2C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3045
Practice Address - Country:US
Practice Address - Phone:570-691-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASL013268235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program