Provider Demographics
NPI:1205126968
Name:DOWLING, MELINDA ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ROSE
Last Name:DOWLING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ROSE
Other - Last Name:DEVANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:814 S MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4231
Mailing Address - Country:US
Mailing Address - Phone:646-298-5246
Mailing Address - Fax:
Practice Address - Street 1:814 S MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-4231
Practice Address - Country:US
Practice Address - Phone:646-298-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005155A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist