Provider Demographics
NPI:1083964779
Name:ARTMAN, MARISSA CLAIRE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:CLAIRE
Last Name:ARTMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 STARBOARD LNDG
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-2779
Mailing Address - Country:US
Mailing Address - Phone:317-225-8349
Mailing Address - Fax:
Practice Address - Street 1:475 STARBOARD LNDG
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-2779
Practice Address - Country:US
Practice Address - Phone:317-225-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011927235Z00000X
IN22006452A235Z00000X
CA24801235Z00000X
OK4270235Z00000X
TX113013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist