Provider Demographics
NPI:1548374804
Name:PETERS, MELINDA RICE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:RICE
Last Name:PETERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:R
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:527 SWEETWATER RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-8874
Mailing Address - Country:US
Mailing Address - Phone:828-675-9634
Mailing Address - Fax:
Practice Address - Street 1:527 SWEETWATER RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-8874
Practice Address - Country:US
Practice Address - Phone:828-675-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2501235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7401033Medicaid