Individual provider Active NPI

Jessica Melquist, CCC-SLP

  • Speech-Language Pathologist
  • Waconia, MN
National Provider Identifier
1740747286
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
10318 Issued in MN
Practice address
9346 Oak Ave
Waconia, MN 55387-9422
Phone
(952) 223-2506
NPI assigned
Feb 20, 2019
Last updated
Jul 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 10318 MN Primary

Addresses

Primary practice location

9346 Oak Ave
Waconia, MN 55387-9422

Mailing address

9346 Oak Ave
Waconia, MN 55387-9422
Phone (952) 223-2506

Other practice location 1

3401 45th St S
Fargo, ND 58104-8970
Phone (701) 356-4384

Other practice location 2

3060 Frontier Way S
Fargo, ND 58104-8909
Phone (701) 232-2340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1712NDMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Therapy Partners, Inc. CurrentSince Nov 1, 2020 Accepting new patients
NPI 1083910871 Past Accepting new patients

Locations

3060 Frontier Way S
Fargo, ND 58104
Phone (701) 356-4384

3401 45th St S
Fargo, ND 58104
Phone (701) 356-4384

3401 45th St S
#A
Fargo, ND 58104
Phone (701) 356-4384

Interoperability endpoints

  • Direct secure messaging: jvankeulen414679@excellian.direct.allina.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1740747286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9346 OAK AVE",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553879422",
            "telephone_number": "952-223-2506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9346 OAK AVE",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553879422",
            "telephone_number": "952-223-2506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 45th St S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581048970",
            "country_code": "US",
            "telephone_number": "701-356-4384",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3060 Frontier Way S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581048909",
            "country_code": "US",
            "telephone_number": "701-232-2340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELQUIST",
        "first_name": "JESSICA",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-20",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "10318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waconia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; 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.