Provider Demographics
NPI:1649698739
Name:MACCONI, MELISSA ROSE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:MACCONI
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 1:3 JENNY LYNN CT APT L
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-3507
Mailing Address - Country:US
Mailing Address - Phone:609-970-8285
Mailing Address - Fax:
Practice Address - Street 1:3 JENNY LYNN CT APT L
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-3507
Practice Address - Country:US
Practice Address - Phone:609-970-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist