Provider Demographics
NPI:1073042321
Name:TOMCZAK, MARISSA FRANCES (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:FRANCES
Last Name:TOMCZAK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GROVE DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1646
Mailing Address - Country:US
Mailing Address - Phone:585-356-5476
Mailing Address - Fax:
Practice Address - Street 1:210 CLIFTON SPRINGS PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1041
Practice Address - Country:US
Practice Address - Phone:315-906-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist