Provider Demographics
NPI:1851537625
Name:LIGHT, MELISSA L (M ED)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:L
Last Name:LIGHT
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 S WAKEFIELD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-3084
Mailing Address - Country:US
Mailing Address - Phone:703-685-1070
Mailing Address - Fax:703-685-0151
Practice Address - Street 1:939 S WAKEFIELD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3084
Practice Address - Country:US
Practice Address - Phone:703-685-1070
Practice Address - Fax:703-685-0151
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist