Provider Demographics
NPI:1861493322
Name:BUELOW, MELISSA A (SLPCCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BUELOW
Suffix:
Gender:F
Credentials:SLPCCC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:BOEHNKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPCCC
Mailing Address - Street 1:640 OAK RIDGE RD
Mailing Address - Street 2:APT 328
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4854
Mailing Address - Country:US
Mailing Address - Phone:952-237-9148
Mailing Address - Fax:
Practice Address - Street 1:3305 CENTRAL PARK VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-7707
Practice Address - Country:US
Practice Address - Phone:952-285-2840
Practice Address - Fax:952-285-2830
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist