Provider Demographics
NPI:1679935852
Name:KEFFER, MELANIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:KEFFER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10085 RACCOON CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9605
Mailing Address - Country:US
Mailing Address - Phone:775-622-5735
Mailing Address - Fax:
Practice Address - Street 1:1565 VIRGINIA RANCH RD
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5704
Practice Address - Country:US
Practice Address - Phone:844-570-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1844 PROVISIONAL235Z00000X
NVSP-1844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1679935852Medicaid