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Individual

MELISSA FUQUA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA-CCC-SLP

Contact information

Practice address
146 TIMBER CREEK DR STE 101, CORDOVA, TN 38018-4396
(901) 654-5693
(855) 978-0933
Mailing address
146 TIMBER CREEK DR STE 101, CORDOVA, TN 38018-4396
(901) 654-5693
(855) 978-0933

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5603
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5603
STATE LICENSE
TN
Enumeration date
10/30/2012
Last updated
02/28/2025
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