Provider Demographics
NPI:1871886986
Name:HEDRICK, MELYSSA ELLEN
Entity type:Individual
Prefix:MS
First Name:MELYSSA
Middle Name:ELLEN
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 RIDDLE AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2642
Mailing Address - Country:US
Mailing Address - Phone:304-906-7598
Mailing Address - Fax:
Practice Address - Street 1:130 KAUFMAN DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2179
Practice Address - Country:US
Practice Address - Phone:304-363-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVP/SLP-0508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist