Provider Demographics
NPI:1376957332
Name:CHINISON, MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CHINISON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:CARMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3215 CUMING ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2000
Mailing Address - Country:US
Mailing Address - Phone:402-557-2565
Mailing Address - Fax:402-557-2478
Practice Address - Street 1:7310 S 48TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68157-2265
Practice Address - Country:US
Practice Address - Phone:402-734-5011
Practice Address - Fax:402-734-1365
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2016005210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist