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NPI Code Detail

MEDICARE: MELISSA ANN BLACK MA, SLP

MEDICARE: MELISSA ANN BLACK MA, 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 Pathologist

General Provider Information

NPI Number : 1730854852
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA ANN BLACK MA, SLP
Provider Business Mailing Address
First Line : 273 GLEN HOLLOW DR
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63017-2807
Country : US
Telephone Number : 616-724-5564
Fax Number :
Provider Business Practice Location Address
First Line : 3420 HARRY S TRUMAN BLVD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-4046
Country : US
Telephone Number : 636-926-2700
Fax Number : 636-277-4548
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2021
Last Update Date : 07/20/2023

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Directions to “ MELISSA ANN BLACK MA, SLP” Practice Location

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