MEDICARE: MELISSA SPAULDING M.S.CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1245515873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SPAULDING M.S.CCC-SLP

Provider Business Mailing Address
First Line	:	680 S 4TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-2407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 PROFESSIONAL DR
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-3221
Country	:	US
Telephone Number	:	252-535-3028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	02/09/2015

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