Melissa Lynn Mortenson, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

004113 Issued in CT

Practice address

333 1St St N
Suite 200
Jacksonville Beach, FL 32250-6945

Phone

(318) 512-1842

NPI assigned

Apr 9, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239235200000",
    "number": "1063655819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ANDREW LANE",
            "address_2": "BOX 1295",
            "city": "PINEDALE",
            "state": "WY",
            "postal_code": "829411295",
            "telephone_number": "318-512-1842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 1ST ST N",
            "address_2": "SUITE 200",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322506945",
            "telephone_number": "318-512-1842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSON",
        "first_name": "MELISSA",
        "middle_name": "LYNN",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-09",
        "last_updated": "2009-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "004113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Lawrence Morgan, M.D.
• Christine Morley, APRN
• Casey George Morris, DC
• John Arthur Morris, DC
• Leah Mortensen, COTA/L
• Raven Mott, DPT
• Janet Moulton, CCC-SLP
• Melissa Moulton, MSW
• Malinda M. Moussa, A.P.R.N.
• Maria E. Moutinho, M.D.

• Speech-Language Pathologist in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.