Provider Demographics
NPI:1326446832
Name:MARINO, JUDI ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JUDI
Middle Name:ANN
Last Name:MARINO
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 1:1938 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2161
Mailing Address - Country:US
Mailing Address - Phone:847-780-8130
Mailing Address - Fax:
Practice Address - Street 1:1938 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2161
Practice Address - Country:US
Practice Address - Phone:847-780-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist