Provider Demographics
NPI:1760655070
Name:TRAYLOR, MELODY A (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:A
Last Name:TRAYLOR
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 1:1011 CANYON BEND DR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3913
Mailing Address - Country:US
Mailing Address - Phone:480-259-7142
Mailing Address - Fax:
Practice Address - Street 1:1011 CANYON BEND DR
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3913
Practice Address - Country:US
Practice Address - Phone:480-259-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ002750Medicaid