Provider Demographics
NPI:1609566124
Name:ENTZ, MELEA (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELEA
Middle Name:
Last Name:ENTZ
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 S SYRACUSE WAY STE 260
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4739
Mailing Address - Country:US
Mailing Address - Phone:720-314-8570
Mailing Address - Fax:
Practice Address - Street 1:6200 S SYRACUSE WAY STE 260
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4739
Practice Address - Country:US
Practice Address - Phone:720-314-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist