Provider Demographics
NPI:1730582727
Name:BARRIOS, MELISSA (CCC/SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BARRIOS
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 1:12328 S 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-1515
Mailing Address - Country:US
Mailing Address - Phone:402-321-3039
Mailing Address - Fax:
Practice Address - Street 1:12328 S 73RD AVE
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-1515
Practice Address - Country:US
Practice Address - Phone:402-321-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074794235Z00000X
NE1688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist