Basic Information
| Provider Information | |||||||||
| NPI: | 1003151895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLASS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22595 RAMBLE RD | ||||||||
| Address2: | |||||||||
| City: | LEWES | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199586860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107631212 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17026 CADBURY CIR | ||||||||
| Address2: | |||||||||
| City: | LEWES | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199587022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107631212 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2012 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 04-0000320 | DE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.