Provider Demographics
NPI:1134909096
Name:JOLLEY, MEGHAN LEIGH (AUD)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LEIGH
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 ARENDALE SQ
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-1217
Mailing Address - Country:US
Mailing Address - Phone:772-240-9379
Mailing Address - Fax:
Practice Address - Street 1:1005 N GLEBE RD STE 500
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5702
Practice Address - Country:US
Practice Address - Phone:703-644-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001644231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist