MEDICARE: MELISSA ANNE MIMIDIS HORWATT M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	50-1216113	PA
2	235Z00000X	Speech-Language Pathologist	2202005366	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	231365369	OTHER	PA	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1669435863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNE MIMIDIS HORWATT M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	450 W BROAD ST
Second Line	:	SUITE 215
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3340
Country	:	US
Telephone Number	:	703-533-8819
Fax Number	:	703-533-7723

Provider Business Practice Location Address
First Line	:	8270 WILLOW OAKS CORPORATE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4530
Country	:	US
Telephone Number	:	571-423-4900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/17/2024

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Directions to “ MELISSA ANNE MIMIDIS HORWATT M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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