Provider Demographics
NPI:1164822656
Name:WODZINSKI, MARYANN (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:WODZINSKI
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:FRISINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 NEDRA LANE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-984-1197
Mailing Address - Fax:
Practice Address - Street 1:200 NEDRA LANE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-984-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017216-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist