MEDICARE: MELISSA LIECHTY MSP, 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	7796	NC

General Provider Information

NPI Number	:	1255523825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LIECHTY MSP, CCC-SLP

Provider Business Mailing Address
First Line	:	2101 PATCHEN LAKE LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-2563
Country	:	US
Telephone Number	:	270-635-1634
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 PATCHEN LAKE LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-2563
Country	:	US
Telephone Number	:	270-635-1634
Fax Number	:

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	10/13/2022

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