Provider Demographics
NPI:1730170218
Name:MENZIES, MELISSA L (MA, AUDCCC-A)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:MENZIES
Suffix:
Gender:F
Credentials:MA, AUDCCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 N EUCLID AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2483
Mailing Address - Country:US
Mailing Address - Phone:989-684-4400
Mailing Address - Fax:989-684-0560
Practice Address - Street 1:4175 N EUCLID AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2483
Practice Address - Country:US
Practice Address - Phone:989-684-4400
Practice Address - Fax:989-684-0560
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12068281231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619069523OtherGROUP NPI
MI3501004541OtherHEARING AID DEALER LICENSE STATE OF MICHIGAN
MI170Z911460OtherBCBS PIN
MI12068281OtherASHA
MI170Z911460OtherBCBS PIN