Provider Demographics
NPI:1730379199
Name:MELILLO, JENNIFER ANNE (SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:MELILLO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:MELILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:3301 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-5127
Mailing Address - Country:US
Mailing Address - Phone:513-451-1551
Mailing Address - Fax:513-451-1534
Practice Address - Street 1:3301 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5127
Practice Address - Country:US
Practice Address - Phone:513-451-1551
Practice Address - Fax:513-451-1534
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2007176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187155Medicaid