Provider Demographics
NPI:1740404581
Name:PALCIC, MELANIE J (MA-CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:J
Last Name:PALCIC
Suffix:
Gender:F
Credentials:MA-CCC, SLP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20104
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81019-2104
Mailing Address - Country:US
Mailing Address - Phone:719-251-2398
Mailing Address - Fax:719-676-2351
Practice Address - Street 1:6230 WACO MISH ROAD
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019-2104
Practice Address - Country:US
Practice Address - Phone:719-251-2398
Practice Address - Fax:719-676-2351
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45159211Medicaid