Provider Demographics
NPI:1689402232
Name:GIARDINA, MARISSA MARGARET (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:MARGARET
Last Name:GIARDINA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 BRANDYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2402
Mailing Address - Country:US
Mailing Address - Phone:609-576-0494
Mailing Address - Fax:
Practice Address - Street 1:2108 BRANDYWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-2402
Practice Address - Country:US
Practice Address - Phone:609-576-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01241000235Z00000X
DEO1-0012340235Z00000X
NJ14400200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist