MEDICARE: MS. MELISSA FRANCES POWELL M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	111706	TX

General Provider Information

NPI Number	:	1053896068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA FRANCES POWELL M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1945 N GARRETT AVE APT 2006
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-8684
Country	:	US
Telephone Number	:	978-502-2184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1945 N GARRETT AVE APT 2006
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-8684
Country	:	US
Telephone Number	:	978-502-2184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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