Healthcare Provider Details

I. General information

NPI: 1568376002
Provider Name (Legal Business Name): MELISSA NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 N LAKE PLEASANT RD
ATTICA MI
48412-9770
US

IV. Provider business mailing address

5457 THOMAS RD
METAMORA MI
48455-9289
US

V. Phone/Fax

Practice location:
  • Phone: 810-338-1875
  • Fax:
Mailing address:
  • Phone: 810-338-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14112337
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: