Provider Demographics
NPI:1528498904
Name:DEFACIO, MELISSA MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:DEFACIO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:18155 MARINE VIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3839
Mailing Address - Country:US
Mailing Address - Phone:253-874-9300
Mailing Address - Fax:206-374-2533
Practice Address - Street 1:535 DOCK ST
Practice Address - Street 2:SUITE 104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4614
Practice Address - Country:US
Practice Address - Phone:253-874-9300
Practice Address - Fax:206-374-2533
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WALL60405675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist