Provider Demographics
NPI:1740312271
Name:EGGLESTON, MELISSA (MA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-3719
Mailing Address - Country:US
Mailing Address - Phone:314-762-0034
Mailing Address - Fax:
Practice Address - Street 1:4144 LINDELL BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2932
Practice Address - Country:US
Practice Address - Phone:314-704-5727
Practice Address - Fax:314-289-7545
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist