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NPI Code Detail

MEDICARE: MELISSA WEBSTER MS, CCC-SLP

MEDICARE: MELISSA WEBSTER MS, 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
1235Z00000XSpeech-Language Pathologist103860TX

General Provider Information

NPI Number : 1083002042
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA WEBSTER MS, CCC-SLP
Provider Business Mailing Address
First Line : 1701 ROGERS RD APT 532
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-6586
Country : US
Telephone Number : 918-605-6264
Fax Number :
Provider Business Practice Location Address
First Line : 5801 BRYANT IRVIN RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4209
Country : US
Telephone Number : 817-346-3030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2014
Last Update Date : 12/29/2014

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