Provider Demographics
NPI:1295977965
Name:SHULTZ, MELANIE (M,A, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:M,A, 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:PO BOX 1773
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-1773
Mailing Address - Country:US
Mailing Address - Phone:614-596-4958
Mailing Address - Fax:
Practice Address - Street 1:8425 PULSAR PL
Practice Address - Street 2:SUITE 160
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2079
Practice Address - Country:US
Practice Address - Phone:614-596-4958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5684235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000208326OtherANTHEM
OH$$$$$$$$$002OtherMEDICAL MUTUAL