Individual
MRS. STEPHANIE L MELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC SLP
Contact information
Practice address
124 HAMMOND DR, CANTON, GA 30114-6558
(678) 492-0400
(678) 493-2052
Mailing address
303 LEGACY DRIVE, CANTON, GA 30115
(678) 492-0400
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006259
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
693050591D
—
GA
Enumeration date
11/10/2006
Last updated
09/25/2019
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