Basic Information
| Provider Information | |||||||||
| NPI: | 1598994774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOEL | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | BIRMINGHAM | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302244214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702296498 | ||||||||
| FaxNumber: | 7702296958 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302244214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702296498 | ||||||||
| FaxNumber: | 7702296958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2009 | ||||||||
| LastUpdateDate: | 07/08/2009 | ||||||||
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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 | SLP006223 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.