Healthcare Provider Details

I. General information

NPI: 1639579097
Provider Name (Legal Business Name): MELISSA BENDIXSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 UNDERWOOD ST
HOLLISTON MA
01746-1510
US

IV. Provider business mailing address

465 UNDERWOOD ST
HOLLISTON MA
01746-1510
US

V. Phone/Fax

Practice location:
  • Phone: 774-527-9612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number34407
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP-2634
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP101623
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-2808
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: