Healthcare Provider Details

I. General information

NPI: 1578609426
Provider Name (Legal Business Name): MELISSA LYNN JARRELL MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA LYNN HUDSON MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17507 LEE HWY
ABINGDON VA
24210-7835
US

IV. Provider business mailing address

17507 LEE HWY
ABINGDON VA
24210-7835
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6043
  • Fax: 888-233-7885
Mailing address:
  • Phone: 276-525-6043
  • Fax: 888-233-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202004314
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: