Melissa D Boerner, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

S2490 Issued in MS

Practice address

20 The Rays TRL SE
Bogue Chitto, MS 39629-8500

Phone

(601) 833-8363

NPI assigned

Jun 8, 2007

Last updated

Jul 8, 2007By 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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Speech Pathology Associates, Inc.

  • Speech-Language Pathologist
  • Bogue Chitto, MS
  • NPI 1073676623
  NPD (past)

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841493517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 S CHURCH ST",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396013810",
            "telephone_number": "601-833-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 THE RAYS TRL SE",
            "city": "BOGUE CHITTO",
            "state": "MS",
            "postal_code": "396298500",
            "telephone_number": "601-833-8363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERNER",
        "first_name": "MELISSA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S2490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00580206",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy Carole Bass, CCC-SLP
• Barbara Faye Buie, PH.D, GC-C, IDD
• Annette Edwards
• Family Health Care Clinic, Inc.
• Jeffrey Gatlin
• Sarah Guthrie

• Speech-Language Pathologist in Bogue Chitto, MS
• Providers in Bogue Chitto, MS by specialty
• Speech-Language Pathologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.