Provider Demographics
NPI:1053723510
Name:PATRICK, MARISSA EILEEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:EILEEN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:EILEEN
Other - Last Name:MUNGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 BAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2180
Mailing Address - Country:US
Mailing Address - Phone:205-821-6770
Mailing Address - Fax:
Practice Address - Street 1:1216 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5507
Practice Address - Country:US
Practice Address - Phone:903-893-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist