Provider Demographics
NPI:1821660010
Name:MESSAM-PARKER, LETICIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:MESSAM-PARKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 WHISPERING LEAF TRL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7945
Mailing Address - Country:US
Mailing Address - Phone:813-843-5382
Mailing Address - Fax:
Practice Address - Street 1:4641 MONTGOMERY AVE STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3430
Practice Address - Country:US
Practice Address - Phone:301-288-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16530235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist