Provider Demographics
NPI:1326117375
Name:MARINO, MELISSA ANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:MARINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2039
Mailing Address - Country:US
Mailing Address - Phone:330-945-5600
Mailing Address - Fax:990-945-6222
Practice Address - Street 1:3512 KENT RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4602
Practice Address - Country:US
Practice Address - Phone:330-689-5322
Practice Address - Fax:330-686-4716
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCSP 2006139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH729035OtherBUCKEYE HEALTH PLAN
OH0849916Medicaid