Basic Information
Provider Information | |||||||||
NPI: | 1063654291 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FOX | ||||||||
FirstName: | MELISSA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S., CCC-SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4950 GOVERNMENT BLVD | ||||||||
Address2: | APT. 217 | ||||||||
City: | MOBILE | ||||||||
State: | AL | ||||||||
PostalCode: | 366935062 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2514901092 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 245 CAHABA VALLEY PKWY | ||||||||
Address2: | SUITE 200 | ||||||||
City: | PELHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 351242216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2059426820 | ||||||||
FaxNumber: | 2059425884 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/02/2009 | ||||||||
LastUpdateDate: | 04/02/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2610 | AL | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
No ID Information.