Basic Information
| Provider Information | |||||||||
| NPI: | 1760709273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDMONDSON | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | ST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3371 CLEVELAND ROAD EXT | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466289780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742712558 | ||||||||
| FaxNumber: | 5742731137 | ||||||||
| Practice Location | |||||||||
| Address1: | 51738 SAGECREST DR | ||||||||
| Address2: | |||||||||
| City: | GRANGER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465306887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743395959 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2010 | ||||||||
| LastUpdateDate: | 04/23/2010 | ||||||||
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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 | 22004984A | IN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.