Provider Demographics
NPI:1417259573
Name:TOVAR, MELINDA BROOKE (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:BROOKE
Last Name:TOVAR
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:BROOKE
Other - Last Name:LIGHTSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:14415 E STATE ROAD 70
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8414
Mailing Address - Country:US
Mailing Address - Phone:941-758-3140
Mailing Address - Fax:941-870-4891
Practice Address - Street 1:14415 E STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8414
Practice Address - Country:US
Practice Address - Phone:941-758-3140
Practice Address - Fax:941-870-4891
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist