MEDICARE: MELISSA DOBBS

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	103K00000X	Behavior Analyst	100010	AK
2	235Z00000X	Speech-Language Pathologist	105335	AK

General Provider Information

NPI Number	:	1992188478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DOBBS

Provider Business Mailing Address
First Line	:	PO BOX 879455
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99687-9455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4272 SOUTH TIMBERLAND LOOP
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-0000
Country	:	US
Telephone Number	:	907-841-6377
Fax Number	:

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

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	01/22/2016

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Directions to “ MELISSA DOBBS ” Practice Location

Language	Start Address	Practice Location

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