Healthcare Provider Details

I. General information

NPI: 1831840578
Provider Name (Legal Business Name): MELISSA RYAN COLLIER M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 SUGARTREE CIR
LIPAN TX
76462-4311
US

IV. Provider business mailing address

174 SUGARTREE CIR
LIPAN TX
76462-4311
US

V. Phone/Fax

Practice location:
  • Phone: 254-631-6301
  • Fax:
Mailing address:
  • Phone: 254-631-6301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104094
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: