1952462145 NPI number — MS. MELISSA CHRISTINE WILSON SLP

Table of content: MS. MELISSA CHRISTINE WILSON SLP (NPI 1952462145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952462145 NPI number — MS. MELISSA CHRISTINE WILSON SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
MELISSA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952462145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24258
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87502-9258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-424-8777
Provider Business Mailing Address Fax Number:
505-424-9777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 CALLE MEDICO
Provider Second Line Business Practice Location Address:
681 CALLECITA JICARILLA
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-424-8777
Provider Business Practice Location Address Fax Number:
505-424-9777
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  457 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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