Basic Information
| Provider Information | |||||||||
| NPI: | 1487934451 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLAGOMEZ | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CFY-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 N WABASH RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469521300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656513229 | ||||||||
| FaxNumber: | 7656513227 | ||||||||
| Practice Location | |||||||||
| Address1: | 2350 TAFT ST | ||||||||
| Address2: | |||||||||
| City: | GARY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464043349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199772600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2011 | ||||||||
| LastUpdateDate: | 08/23/2011 | ||||||||
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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 | 46002234A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.