Provider Demographics
NPI:1609293364
Name:THOMAS, MELISSA (SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2443 SULLIVAN CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6693
Mailing Address - Country:US
Mailing Address - Phone:615-426-3438
Mailing Address - Fax:
Practice Address - Street 1:2443 SULLIVAN CT
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6693
Practice Address - Country:US
Practice Address - Phone:615-426-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184517OtherMEDICARE
KY45118379Medicaid