Provider Demographics
NPI:1730854852
Name:BLACK, MELISSA ANN (MA, SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:BLACK
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SCHUDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:273 GLEN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2807
Mailing Address - Country:US
Mailing Address - Phone:616-724-5564
Mailing Address - Fax:
Practice Address - Street 1:3420 HARRY S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4046
Practice Address - Country:US
Practice Address - Phone:636-926-2700
Practice Address - Fax:636-277-4548
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist