Provider Demographics
NPI:1104073725
Name:MELTON, REBEKAH LYN (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYN
Last Name:MELTON
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3114
Mailing Address - Country:US
Mailing Address - Phone:608-316-1186
Mailing Address - Fax:608-252-1333
Practice Address - Street 1:2875 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3114
Practice Address - Country:US
Practice Address - Phone:608-316-1186
Practice Address - Fax:608-252-1333
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104073725Medicaid