Provider Demographics
NPI:1548509243
Name:MEACHAM, MELISSA L
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SUMMERGLEN RDG
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8319
Mailing Address - Country:US
Mailing Address - Phone:757-810-2787
Mailing Address - Fax:
Practice Address - Street 1:109 SUMMERGLEN RDG
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8319
Practice Address - Country:US
Practice Address - Phone:757-810-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist