Healthcare Provider Details

I. General information

NPI: 1982038865
Provider Name (Legal Business Name): MELISSA LEGENDRE M.ED. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 TOWN PLAZA CT STE 1612
WINTER SPRINGS FL
32708-6210
US

IV. Provider business mailing address

524 CANYON STONE CIR
LAKE MARY FL
32746-3954
US

V. Phone/Fax

Practice location:
  • Phone: 407-580-8500
  • Fax: 321-281-4942
Mailing address:
  • Phone: 305-801-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12294
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: