1508213349 NPI number — MELISSA MADDOX COOK M.ED. CCC-SLP

Table of content: LEXIE JO PHILLIPS FNP (NPI 1700415858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508213349 NPI number — MELISSA MADDOX COOK M.ED. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
MELISSA
Provider Middle Name:
MADDOX
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MADDOX
Provider Other First Name:
MELISSA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508213349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1516 BAYBERRY CT N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-332-0325
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2117 MCCOMAS WAY STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23456-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-427-5505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  0004085 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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