Provider Demographics
NPI:1265185052
Name:SHEPHARD, MELANIE (MA, SLP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SHEPHARD
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:BREMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59429 CLOVER RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-9406
Mailing Address - Country:US
Mailing Address - Phone:574-309-6922
Mailing Address - Fax:
Practice Address - Street 1:1147 S 3RD ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-3472
Practice Address - Country:US
Practice Address - Phone:269-684-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist