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General NPI Number Information
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NPI Number | 1083996904
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Entity Type | Individual
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Provider Name | MELISSA JO MAYETTE M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 84 NIGHTENGALE AVE
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City | MASSENA
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State | NY
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Zip | 13662-2538
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Country | US
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Telephone | 315-764-3740
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Fax | 315-764-3743
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Provider Business Mailing Address
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Address Line | 30 WILLIAM MANOR DR
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City | WADDINGTON
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State | NY
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Zip | 13694-4117
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Country | US
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Telephone | 315-388-5309
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 012685
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License Number State | NY
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