Provider Demographics
NPI:1467199406
Name:BRUSH, MELISSA TAIT (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:TAIT
Last Name:BRUSH
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 FARRAGUT DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2307
Mailing Address - Country:US
Mailing Address - Phone:540-706-7031
Mailing Address - Fax:
Practice Address - Street 1:3315 PURVIS RD
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-2101
Practice Address - Country:US
Practice Address - Phone:571-660-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist