Provider Demographics
NPI:1396913299
Name:BREWSTER, MELISSA RENEE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RENEE
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 WEST AVENUE P.O. BOX 301
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:CO
Mailing Address - Zip Code:80535
Mailing Address - Country:US
Mailing Address - Phone:970-472-1379
Mailing Address - Fax:
Practice Address - Street 1:3004 WEST AVE
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:CO
Practice Address - Zip Code:80535
Practice Address - Country:US
Practice Address - Phone:970-472-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12052787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist