Basic Information
| Provider Information | |||||||||
| NPI: | 1134233356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELLETT | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DEMONTE | ||||||||
| OtherFirstName: | DEBRA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 83 | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080370083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
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| Practice Location | |||||||||
| Address1: | 640 S WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HAMMONTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080372014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6097041980 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 07/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 41YS00517500 | NJ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.