Provider Demographics
NPI:1700171931
Name:HARTMAN, MELISSA KAY (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KAY
Last Name:HARTMAN
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 1:440 HIGHWAY 59 LOOP S
Mailing Address - Street 2:STE 104
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9096
Mailing Address - Country:US
Mailing Address - Phone:936-328-8148
Mailing Address - Fax:936-327-2491
Practice Address - Street 1:440 HIGHWAY 59 LOOP S
Practice Address - Street 2:STE 104
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9096
Practice Address - Country:US
Practice Address - Phone:936-328-8148
Practice Address - Fax:936-327-2491
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282205802Medicaid
TX282205801Medicaid