Provider Demographics
NPI:1174773022
Name:MAGUIRE, MELISSA (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MAGUIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSCCCSLP
Mailing Address - Street 1:107 MOHONK RD
Mailing Address - Street 2:
Mailing Address - City:HIGH FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12440-5241
Mailing Address - Country:US
Mailing Address - Phone:845-687-4105
Mailing Address - Fax:
Practice Address - Street 1:107 MOHONK RD
Practice Address - Street 2:
Practice Address - City:HIGH FALLS
Practice Address - State:NY
Practice Address - Zip Code:12440-5241
Practice Address - Country:US
Practice Address - Phone:845-687-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist