Healthcare Provider Details

I. General information

NPI: 1659320588
Provider Name (Legal Business Name): MELANIE LEE PHILLIPS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE LEE CANAVAN AUD

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NW ENGLEWOOD RD
GLADSTONE MO
64118-4063
US

IV. Provider business mailing address

6 VICTORY DR
LIBERTY MO
64068-1973
US

V. Phone/Fax

Practice location:
  • Phone: 816-313-2800
  • Fax: 816-792-9819
Mailing address:
  • Phone: 816-313-2800
  • Fax: 816-792-9819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2004017426
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2000
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: