MEDICARE: MELISSA ROSE GABRIELSEN SLPA

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	2355S0801X	Speech-Language Assistant	SLPA10027	AZ

General Provider Information

NPI Number	:	1265881338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ROSE GABRIELSEN SLPA

Provider Business Mailing Address
First Line	:	12484 N 76TH ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-4814
Country	:	US
Telephone Number	:	480-406-7760
Fax Number	:

Provider Business Practice Location Address
First Line	:	12484 N 76TH ST
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-4814
Country	:	US
Telephone Number	:	480-406-7760
Fax Number	:

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/08/2016

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Directions to “ MELISSA ROSE GABRIELSEN SLPA” Practice Location

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