Provider Demographics
NPI:1801967989
Name:MONTIEL, MELISSA JO (MA CCC-SLP, COM)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JO
Last Name:MONTIEL
Suffix:
Gender:F
Credentials:MA CCC-SLP, COM
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:J
Other - Last Name:ESPENHOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:259 ANTELOPE VILLAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2273
Mailing Address - Country:US
Mailing Address - Phone:702-755-7798
Mailing Address - Fax:702-982-1682
Practice Address - Street 1:2441 WEST HORIZON RIDGE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-755-7798
Practice Address - Fax:702-755-7798
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP1096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509889Medicaid