Provider Demographics
NPI:1659054567
Name:WIGHT, MELANIE LAUREL (HIS)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LAUREL
Last Name:WIGHT
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 MARTIN LUTHER KING JR WAY APT 115
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4157
Mailing Address - Country:US
Mailing Address - Phone:253-365-5676
Mailing Address - Fax:
Practice Address - Street 1:15215 SE 272ND ST STE 104
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-9918
Practice Address - Country:US
Practice Address - Phone:253-520-7786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA61241578237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist