Provider Demographics
NPI:1720137987
Name:KAUFFMAN, MELANIE RENEE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:RENEE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 ABERNATHY ST
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-2906
Mailing Address - Country:US
Mailing Address - Phone:870-352-5033
Mailing Address - Fax:
Practice Address - Street 1:1717 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-7104
Practice Address - Country:US
Practice Address - Phone:870-352-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSP #858OtherSTATE LICENSURE
AR132032721Medicaid
AR01090743OtherASHA ACCOUNT NUMBER