Individual
LAUREN MELLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
6124 FALCON LANE, JEFFERSON CITY, MO 65101
(573) 634-2053
Mailing address
710 E 7TH ST APT 109, CHARLOTTE, NC 28202-3034
(704) 692-5424
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11893
NC
235Z00000X
Speech-Language Pathologist
20170318
MO
235Z00000X
Speech-Language Pathologist
229644
MA
235Z00000X
Speech-Language Pathologist
SLP-SP-LIC-6639
MT
Other
Enumeration date
09/29/2017
Last updated
09/29/2017
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