Provider Demographics
NPI:1871965251
Name:RAUPP, MELISSA ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:RAUPP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 DOTY RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-7517
Mailing Address - Country:US
Mailing Address - Phone:815-334-3841
Mailing Address - Fax:815-334-3826
Practice Address - Street 1:3703 DOTY RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-7517
Practice Address - Country:US
Practice Address - Phone:815-334-3841
Practice Address - Fax:815-334-3826
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist