Provider Demographics
NPI:1780354928
Name:MILLER, MELISSA NICOLE (SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:NICOLE
Other - Last Name:LICHTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:13063 ROAD 34 1/2
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8464
Mailing Address - Country:US
Mailing Address - Phone:559-360-3808
Mailing Address - Fax:
Practice Address - Street 1:1752 E BULLARD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5864
Practice Address - Country:US
Practice Address - Phone:559-970-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist