Provider Demographics
NPI:1124532700
Name:PIRKLE, MELISSA GRACE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:PIRKLE
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 1:5185 MERCEDES AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4362
Mailing Address - Country:US
Mailing Address - Phone:805-471-7483
Mailing Address - Fax:
Practice Address - Street 1:5185 MERCEDES AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4362
Practice Address - Country:US
Practice Address - Phone:805-471-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP28069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist