Provider Demographics
NPI:1952586414
Name:WEAVER, MELISSA D (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9829 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7626
Mailing Address - Country:US
Mailing Address - Phone:318-798-1812
Mailing Address - Fax:
Practice Address - Street 1:9829 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7626
Practice Address - Country:US
Practice Address - Phone:318-798-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist