Provider Demographics
NPI:1245777226
Name:CONNIFF, MARISSA LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LEE
Last Name:CONNIFF
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 1:2102 ATTEND XING
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3794
Mailing Address - Country:US
Mailing Address - Phone:941-661-6954
Mailing Address - Fax:
Practice Address - Street 1:205 PINE BURR ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7760
Practice Address - Country:US
Practice Address - Phone:941-661-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15169235Z00000X
NC13771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist