Provider Demographics
NPI:1770602880
Name:TOLSTIKHINE, MELISSA ANN (AUD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:TOLSTIKHINE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6320
Mailing Address - Country:US
Mailing Address - Phone:541-884-6101
Mailing Address - Fax:541-882-4167
Practice Address - Street 1:123 N 4TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6320
Practice Address - Country:US
Practice Address - Phone:541-884-6101
Practice Address - Fax:541-882-4167
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHASP10120250237600000X
OR22922231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
8802304Medicare ID - Type Unspecified