Provider Demographics
NPI:1427308816
Name:LAND, MELISSA JUNE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JUNE
Last Name:LAND
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 MCCUTCHEON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2081
Mailing Address - Country:US
Mailing Address - Phone:614-817-3464
Mailing Address - Fax:614-547-0702
Practice Address - Street 1:2939 KENNY RD STE 195
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2406
Practice Address - Country:US
Practice Address - Phone:865-803-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12886235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist