Provider Demographics
NPI:1386952778
Name:SMITHSON, MELISSA M (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:SMITHSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:98 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-1547
Mailing Address - Country:US
Mailing Address - Phone:315-894-3640
Mailing Address - Fax:
Practice Address - Street 1:74 COLD BROOK ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:NY
Practice Address - Zip Code:13431-0008
Practice Address - Country:US
Practice Address - Phone:315-826-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014020-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist