Provider Demographics
NPI:1699885525
Name:CONDON, MELINDA CHRISTINE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:CHRISTINE
Last Name:CONDON
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 1:1496 51ST ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-5149
Mailing Address - Country:US
Mailing Address - Phone:360-606-0837
Mailing Address - Fax:
Practice Address - Street 1:3180 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2407
Practice Address - Country:US
Practice Address - Phone:360-606-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist