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General NPI Number Information
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NPI Number | 1124417654
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Entity Type | Individual
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Provider Name | MELISSA GARDNER M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 06/20/2016
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Provider Practice Location Address
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Address Line | 200 E DEL MAR BLVD SUITE #112
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City | PASADENA
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State | CA
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Zip | 91105-2544
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Country | US
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Telephone | 626-564-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 7556 THOUSAND OAKS DR
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City | TUJUNGA
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State | CA
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Zip | 91042-2625
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Country | US
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Telephone | 315-854-4959
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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 | 21202
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License Number State | CA
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