Provider Demographics
NPI:1326718602
Name:SHEPHERD VALLEY, MELODY JOY (EDD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:JOY
Last Name:SHEPHERD VALLEY
Suffix:
Gender:F
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 W CHERYL AVE
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4903
Mailing Address - Country:US
Mailing Address - Phone:817-874-4978
Mailing Address - Fax:
Practice Address - Street 1:8101 BOAT CLUB RD STE 330
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-3633
Practice Address - Country:US
Practice Address - Phone:682-498-3927
Practice Address - Fax:214-935-2457
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108530235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist