Provider Demographics
NPI:1669797924
Name:ANDERSON, MELISSA LOU (MA-CCCA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LOU
Last Name:ANDERSON
Suffix:
Gender:
Credentials:MA-CCCA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LOU
Other - Last Name:HATCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 S DOSSETT DRIVE
Mailing Address - Street 2:PO BOX 70643
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1702
Mailing Address - Country:US
Mailing Address - Phone:423-439-4584
Mailing Address - Fax:423-439-4607
Practice Address - Street 1:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:650 JOEL DRIVE
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000500231H00000X
TN1820231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1601000500OtherSTATE LICENSE
MI1601000500OtherSTATE LICENSE