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NPI Code Detail

MEDICARE: MELISSA B FORNARA MA CCC-SLP

MEDICARE: MELISSA B FORNARA MA 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 PathologistSLP.0004064CO

General Provider Information

NPI Number : 1811517881
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA B FORNARA MA CCC-SLP
Provider Business Mailing Address
First Line : 1015 GARDEN OF THE GODS RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-3489
Country : US
Telephone Number : 719-354-5297
Fax Number :
Provider Business Practice Location Address
First Line : 1015 GARDEN OF THE GODS RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-3489
Country : US
Telephone Number : 719-354-5297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2020
Last Update Date : 01/21/2025

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