Provider Demographics
NPI:1215161450
Name:MYERS, MELANIE E (CCC/SLP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:MYERS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:E
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 26127
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95159-6127
Mailing Address - Country:US
Mailing Address - Phone:408-249-0770
Mailing Address - Fax:408-834-7767
Practice Address - Street 1:1101 S WINCHESTER BLVD
Practice Address - Street 2:SUITE F168
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3901
Practice Address - Country:US
Practice Address - Phone:408-249-0770
Practice Address - Fax:408-834-7767
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12046687OtherASHA CCC-SLP
CA15101OtherCALIFORNIA SLP LICENSE