Provider Demographics
NPI:1508213349
Name:COOK, MELISSA MADDOX (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MADDOX
Last Name:COOK
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1516 BAYBERRY CT N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2704
Mailing Address - Country:US
Mailing Address - Phone:757-332-0325
Mailing Address - Fax:
Practice Address - Street 1:2117 MCCOMAS WAY STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3908
Practice Address - Country:US
Practice Address - Phone:757-427-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004085235Z00000X
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist