Provider Demographics
NPI:1538437538
Name:O'ROURKE, MELANIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 W LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1004
Mailing Address - Country:US
Mailing Address - Phone:623-882-5554
Mailing Address - Fax:
Practice Address - Street 1:6350 W LARIAT LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-1004
Practice Address - Country:US
Practice Address - Phone:623-882-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist