Provider Demographics
NPI:1669041620
Name:BRIDGE, MELISSA ANNE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:BRIDGE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:502-633-1007
Mailing Address - Fax:
Practice Address - Street 1:301 S GALLAHER VIEW RD STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5370
Practice Address - Country:US
Practice Address - Phone:865-328-7410
Practice Address - Fax:615-823-4731
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist