Provider Demographics
NPI:1669282919
Name:VISCONTI, MELODY CHRISTINA
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:CHRISTINA
Last Name:VISCONTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 GLEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1627
Mailing Address - Country:US
Mailing Address - Phone:908-635-2873
Mailing Address - Fax:
Practice Address - Street 1:663 GLEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1627
Practice Address - Country:US
Practice Address - Phone:908-635-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-4540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist