Doctor Name: | MELISSA LYNN MORTENSON |
NPI Number: | 1063655819 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 004113 |
Business Practice Address: | 333 1st St N Suite 200 Jacksonville Beach, FL - 322506945 |
Business Phone Number: | 3185121842 |
Business Fax Number: | |
Mailing Address: | 16 Andrew Lane, Box 1295 PINEDALE |
State: | WY |
Postal Code: | 829411295 |
Phone Number: | 3185121842 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2009 |
NPI Last Update Date: | 04/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 004113 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |