Provider Demographics
NPI:1194440800
Name:MCCLURE, MELISSA DAWN (MA-CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:MCCLURE
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 1:3205 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2039
Mailing Address - Country:US
Mailing Address - Phone:936-709-3767
Mailing Address - Fax:
Practice Address - Street 1:3205 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2039
Practice Address - Country:US
Practice Address - Phone:936-709-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist