Provider Demographics
NPI:1093055568
Name:MCCRARY, MELINA SUZANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELINA
Middle Name:SUZANNE
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 LYNNHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-3107
Mailing Address - Country:US
Mailing Address - Phone:757-332-6411
Mailing Address - Fax:
Practice Address - Street 1:228 LYNNHAVEN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-3107
Practice Address - Country:US
Practice Address - Phone:757-332-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist