Provider Demographics
NPI:1427111723
Name:PELLINEN, MELISSA JOY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JOY
Last Name:PELLINEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:JOY
Other - Last Name:FARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3812 46TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3602
Mailing Address - Country:US
Mailing Address - Phone:612-802-5947
Mailing Address - Fax:952-993-0526
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:612-802-5947
Practice Address - Fax:952-993-0526
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist