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General NPI Number Information
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NPI Number | 1144894924
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Entity Type | Individual
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Provider Name | STACEY LEEANN MELZER MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 220 VILLAGE CIR
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City | PONCA CITY
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State | OK
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Zip | 74601-4021
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Country | US
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Telephone | 580-830-0662
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Fax |
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Provider Business Mailing Address
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Address Line | 16112 LEDGE LN
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City | EDMOND
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State | OK
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Zip | 73013-3227
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Country | US
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Telephone | 575-644-2831
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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 | 14066855
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License Number State | OK
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