Melissa Ann Forker

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

242.003085 Issued in IL

Practice address

45 N. Whittaker St.
Suite 204
New Buffalo, MI 49117

Phone

(269) 235-9821

Fax

(269) 586-2336

NPI assigned

Oct 6, 2014

Last updated

Jun 14, 2021By the provider in NPPES

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

Other names 1

• Melissa Ann Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1412553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1629471537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 N. WHITTAKER ST.",
            "address_2": "SUITE 204",
            "city": "NEW BUFFALO",
            "state": "MI",
            "postal_code": "49117",
            "telephone_number": "269-235-9821",
            "fax_number": "269-586-2336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 N. WHITTAKER ST.",
            "address_2": "SUITE 204",
            "city": "NEW BUFFALO",
            "state": "MI",
            "postal_code": "49117",
            "telephone_number": "269-235-9821",
            "fax_number": "269-586-2336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORKER",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-06",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242.003085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "JOHNSON",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in New Buffalo, MI
• Providers in New Buffalo, MI by specialty
• Speech-Language Pathologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.