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NPI Code Detail

MEDICARE: MELANIE L CANNON MS CCC-SLP

MEDICARE: MELANIE L CANNON 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 Pathologist01870-1NY

General Provider Information

NPI Number : 1750935276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELANIE L CANNON MS CCC-SLP
Provider Business Mailing Address
First Line : 150 PRATHER AVE
Second Line :
City : JAMESTOWN
State : NY
Zip : 14701-6710
Country : US
Telephone Number : 716-338-0135
Fax Number :
Provider Business Practice Location Address
First Line : 150 PRATHER AVE
Second Line :
City : JAMESTOWN
State : NY
Zip : 14701-6710
Country : US
Telephone Number : 716-338-0135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2019
Last Update Date : 08/01/2019

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Directions to “ MELANIE L CANNON MS CCC-SLP” Practice Location

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