Individual
MELANIE POTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
906 CONFIDENCE DR, LONGMONT, CO 80504-8495
(303) 589-2553
Mailing address
906 CONFIDENCE DR, LONGMONT, CO 80504-8495
(303) 589-2553
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
27958361
—
CO
Enumeration date
05/26/2008
Last updated
05/26/2008
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