Provider Demographics
NPI:1952728776
Name:CARROLL, MELANIE ELAINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ELAINE
Last Name:CARROLL
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 1:1440 LAKESIDE AVENUE
Mailing Address - Street 2:LAKESIDE ADMINISTRATION BUILDING
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114
Mailing Address - Country:US
Mailing Address - Phone:216-592-7237
Mailing Address - Fax:
Practice Address - Street 1:1440 LAKESIDE AVENUE
Practice Address - Street 2:LAKESIDE ADMINISTRATION BUILDING
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-592-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP6335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist