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General NPI Number Information
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NPI Number | 1205144698
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Entity Type | Individual
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Provider Name | MELISSA A WHITE M.S. CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 84 GREENWOOD ST
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City | CANISTEO
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State | NY
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Zip | 14823-1230
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Country | US
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Telephone | 607-698-4225
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Fax |
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Provider Business Mailing Address
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Address Line | 10531 COUNTY ROAD 15B
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City | CANASERAGA
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State | NY
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Zip | 14822-9760
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Country | US
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Telephone | 607-324-0247
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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 | 017582
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License Number State | NY
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