Provider Demographics
NPI:1174005458
Name:CASILIO, MARIANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:CASILIO
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 1:2109 NW IRVING ST UNIT 305
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3282
Mailing Address - Country:US
Mailing Address - Phone:541-941-7650
Mailing Address - Fax:
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14129441OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
OR16356OtherSPEECH-LANGUAGE PATHOLOGY LICENSE