Individual
MELISSA GOATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 RUSSELL ROAD, RUSSELLVILLE, AR 72801
(479) 967-2322
Mailing address
PO DRAWER 2109, RUSSELLVILLE, AR 72811
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#2012
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y257
BLUE CROSS BLUE SHIELD
AR
Enumeration date
03/20/2007
Last updated
07/08/2007
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