MEDICARE: MELISSA WHITAKER

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	117188	TX

General Provider Information

NPI Number	:	1598421232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WHITAKER

Provider Business Mailing Address
First Line	:	3505 COLORADO HIGH AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-3338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 ROSS RD
Second Line	:
City	:	DEL VALLE
State	:	TX
Zip	:	78617-3288
Country	:	US
Telephone Number	:	512-386-3010
Fax Number	:

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

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	11/16/2021

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Directions to “ MELISSA WHITAKER ” Practice Location

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