Provider Demographics
NPI:1346885993
Name:NUNNERY, MARISSA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:NUNNERY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14163 BLIND BANDIT CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-4692
Mailing Address - Country:US
Mailing Address - Phone:915-873-1221
Mailing Address - Fax:
Practice Address - Street 1:14163 BLIND BANDIT CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-4692
Practice Address - Country:US
Practice Address - Phone:915-873-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist