Healthcare Provider Details

I. General information

NPI: 1679935852
Provider Name (Legal Business Name): MELANIE KEFFER M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 05/25/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 VIRGINIA RANCH RD
GARDNERVILLE NV
89410-5704
US

IV. Provider business mailing address

10085 RACCOON CT
RENO NV
89523-9605
US

V. Phone/Fax

Practice location:
  • Phone: 844-570-5714
  • Fax:
Mailing address:
  • Phone: 775-622-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1844 PROVISIONAL
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1844
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: