Basic Information
| Provider Information | |||||||||
| NPI: | 1003372731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCK | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3101 S GULLEY RD STE F | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481244406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344072500 | ||||||||
| FaxNumber: | 3137928962 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N STAEBLER RD STE B | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481039755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342526522 | ||||||||
| FaxNumber: | 8442721304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2019 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101006036 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.