Provider Demographics
NPI:1356844880
Name:LARGENT, MELISSA KAUFFMANN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAUFFMANN
Last Name:LARGENT
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 1:411 COURTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3205
Mailing Address - Country:US
Mailing Address - Phone:540-539-5118
Mailing Address - Fax:
Practice Address - Street 1:12 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4110
Practice Address - Country:US
Practice Address - Phone:540-539-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist