Provider Demographics
NPI:1154658185
Name:PHELPS, MELISSA COOKE (HIS)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:COOKE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:DIANNE
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1121 DALLAS DR.
Mailing Address - Street 2:STE 3
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205
Mailing Address - Country:US
Mailing Address - Phone:940-384-7465
Mailing Address - Fax:
Practice Address - Street 1:1121 DALLAS DR.
Practice Address - Street 2:STE 3
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205
Practice Address - Country:US
Practice Address - Phone:940-384-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80321237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist