Provider Demographics
NPI:1316245392
Name:BEARDEN, MELISSA B (MCD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-4565
Mailing Address - Country:US
Mailing Address - Phone:334-872-7001
Mailing Address - Fax:334-872-7033
Practice Address - Street 1:431 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4565
Practice Address - Country:US
Practice Address - Phone:334-872-7001
Practice Address - Fax:334-872-7033
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2992235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist