Provider Demographics
NPI:1124543756
Name:LEVY, MARISSA LYNN (AUD)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:LYNN
Last Name:LEVY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 2ND AVE N STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3287
Mailing Address - Country:US
Mailing Address - Phone:843-732-6090
Mailing Address - Fax:843-491-3573
Practice Address - Street 1:1016 2ND AVE N STE 102
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3287
Practice Address - Country:US
Practice Address - Phone:843-732-6090
Practice Address - Fax:843-491-3573
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X, 237700000X
SC4086231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist