Basic Information
| Provider Information | |||||||||
| NPI: | 1417259573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOVAR | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | BROOKE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. CCC/SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LIGHTSEY | ||||||||
| OtherFirstName: | MELINDA | ||||||||
| OtherMiddleName: | BROOKE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.A CCC/SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14415 E STATE ROAD 70 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342028414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417583140 | ||||||||
| FaxNumber: | 9418704891 | ||||||||
| Practice Location | |||||||||
| Address1: | 14415 E STATE ROAD 70 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342028414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417583140 | ||||||||
| FaxNumber: | 9418704891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 11/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA10000 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.