Provider Demographics
NPI:1982161964
Name:CAMPBELL, MELISSA A (SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:ELWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-0130
Mailing Address - Country:US
Mailing Address - Phone:970-858-2526
Mailing Address - Fax:970-858-8244
Practice Address - Street 1:551 KOKOPELLI BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-6305
Practice Address - Country:US
Practice Address - Phone:970-858-2526
Practice Address - Fax:970-858-8244
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist