Provider Demographics
NPI:1750434841
Name:PLOTNER, MELISSA DAWN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DAWN
Last Name:PLOTNER
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 1:10715 DEL SOL PARK DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5166
Mailing Address - Country:US
Mailing Address - Phone:505-934-4225
Mailing Address - Fax:505-890-5130
Practice Address - Street 1:10715 DEL SOL PARK DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5166
Practice Address - Country:US
Practice Address - Phone:505-934-4225
Practice Address - Fax:505-890-5130
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000A1379Medicaid