Basic Information
Provider Information
NPI: 1215161450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MYERS
FirstName: MELANIE
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: CCC/SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MEYER
OtherFirstName: MELANIE
OtherMiddleName: E
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 26127
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951596127
CountryCode: US
TelephoneNumber: 4082490770
FaxNumber: 4088347767
Practice Location
Address1: 1101 S WINCHESTER BLVD
Address2: SUITE F168
City: SAN JOSE
State: CA
PostalCode: 951283901
CountryCode: US
TelephoneNumber: 4082490770
FaxNumber: 4088347767
Other Information
ProviderEnumerationDate: 05/01/2009
LastUpdateDate: 06/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X15101CAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

ID Information
IDTypeStateIssuerDescription
1510101CACALIFORNIA SLP LICENSEOTHER
1204668701CAASHA CCC-SLPOTHER


Home