Provider Demographics
NPI:1346429222
Name:CAHALAN, MARISA RENEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:RENEE
Last Name:CAHALAN
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 1:644 E 70TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1341
Mailing Address - Country:US
Mailing Address - Phone:816-830-0510
Mailing Address - Fax:
Practice Address - Street 1:644 E 70TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1341
Practice Address - Country:US
Practice Address - Phone:816-830-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007020545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist