Individual
CARON IVY MELLBLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
928 FINNELL WAY, PLACENTIA, CA 92870-4445
(714) 402-8415
Mailing address
928 FINNELL WAY, PLACENTIA, CA 92870-4445
(714) 402-8415
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
110093972
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110093972
SPEECH PATHOLOGIST
CA
Enumeration date
10/27/2011
Last updated
10/27/2011
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