Provider Demographics
NPI:1831441450
Name:YOUNG, MELODY JOY (SLP)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:JOY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:MELODY
Other - Middle Name:JOY
Other - Last Name:PERRIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1024 LAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SUMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98295-9108
Mailing Address - Country:US
Mailing Address - Phone:360-988-9423
Mailing Address - Fax:
Practice Address - Street 1:1024 LAWSON ST
Practice Address - Street 2:
Practice Address - City:SUMAS
Practice Address - State:WA
Practice Address - Zip Code:98295-9108
Practice Address - Country:US
Practice Address - Phone:360-988-9423
Practice Address - Fax:360-988-0505
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60231391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist