Provider Demographics
NPI:1982920096
Name:ROSA, MELINDA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:ROSA
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 1:616 FAHEY ST
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NM
Mailing Address - Zip Code:88023-9738
Mailing Address - Country:US
Mailing Address - Phone:575-538-1404
Mailing Address - Fax:
Practice Address - Street 1:616 FAHEY ST
Practice Address - Street 2:
Practice Address - City:BAYARD
Practice Address - State:NM
Practice Address - Zip Code:88023-9738
Practice Address - Country:US
Practice Address - Phone:575-538-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist