Healthcare Provider Details

I. General information

NPI: 1538180609
Provider Name (Legal Business Name): MELODIE J DREGANSKY MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 STONEYBROOK LN
TEMPERANCE MI
48182-9466
US

IV. Provider business mailing address

2118 STONEYBROOK LN
TEMPERANCE MI
48182-9466
US

V. Phone/Fax

Practice location:
  • Phone: 419-705-0693
  • Fax: 419-705-0693
Mailing address:
  • Phone: 419-705-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: