Individual
MELISSA MAZZAGLIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-CF
Contact information
Practice address
1508 W CAYUSE CREEK DR STE 100, MERIDIAN, ID 83646-6135
(208) 996-0552
(208) 914-6597
Mailing address
1508 W CAYUSE CREEK DR STE 100, MERIDIAN, ID 83646-6135
(208) 996-0552
(208) 914-6597
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP-4219
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790200202
—
ID
05
—
TSLP-4219
—
ID
Enumeration date
01/29/2020
Last updated
01/29/2020
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