Provider Demographics
NPI:1225573074
Name:CHISHOLM, MELISSA GRASSIA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRASSIA
Last Name:CHISHOLM
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 1:953 SW 149TH WAY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1953
Mailing Address - Country:US
Mailing Address - Phone:516-996-7386
Mailing Address - Fax:754-243-8291
Practice Address - Street 1:550 SW 3RD ST STE 304
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6946
Practice Address - Country:US
Practice Address - Phone:516-996-7386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist