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General NPI Number Information
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NPI Number | 1669435863
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Entity Type | Individual
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Provider Name | MELISSA ANNE MIMIDIS HORWATT M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 08/17/2024
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Provider Practice Location Address
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Address Line | 8270 WILLOW OAKS CORPORATE DR
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City | FAIRFAX
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State | VA
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Zip | 22031-4530
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Country | US
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Telephone | 571-423-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 450 W BROAD ST SUITE 215
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3340
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Country | US
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Telephone | 703-533-8819
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Fax | 703-533-7723
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 50-1216113
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202005366
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License Number State | VA
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