Healthcare Provider Details

I. General information

NPI: 1073994612
Provider Name (Legal Business Name): MELISSA COLLEEN MURPHY M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PACIFIC PL
MOUNT VERNON WA
98273-5463
US

IV. Provider business mailing address

PO BOX 2077
PORTLAND OR
97208-2077
US

V. Phone/Fax

Practice location:
  • Phone: 360-416-7570
  • Fax:
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL60570272
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: