Provider Demographics
NPI:1972582484
Name:DRISCOLL, MELANIE G (AUD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:G
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SPECKMAN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1876
Mailing Address - Country:US
Mailing Address - Phone:502-528-3741
Mailing Address - Fax:502-305-2096
Practice Address - Street 1:725 SPECKMAN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1876
Practice Address - Country:US
Practice Address - Phone:502-528-3741
Practice Address - Fax:502-305-2096
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0420231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS70000351Medicaid
KYP66689Medicare UPIN
KY0687818Medicare ID - Type Unspecified