Provider Demographics
NPI:1336384973
Name:SANTACROCE, MELISA E (SLPA, BCBA)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:E
Last Name:SANTACROCE
Suffix:
Gender:F
Credentials:SLPA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 OXNARD ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4976
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:818-449-0994
Practice Address - Street 1:1012 MARQUEZ PL
Practice Address - Street 2:SUITE 211-A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1834
Practice Address - Country:US
Practice Address - Phone:818-345-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM44702355S0801X
NM1-14-17063103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant