Healthcare Provider Details

I. General information

NPI: 1225967995
Provider Name (Legal Business Name): MELISSA CARREON CCC-M.S. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W DUARTE RD STE 707
ARCADIA CA
91007-9247
US

IV. Provider business mailing address

200 N GRAND AVE APT 269
WEST COVINA CA
91791-1755
US

V. Phone/Fax

Practice location:
  • Phone: 626-609-9778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: