Provider Demographics
NPI:1396007639
Name:SIEGEL, MARISSA ROBIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:ROBIN
Last Name:SIEGEL
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 1:17210 SE WOODWARD CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1591
Mailing Address - Country:US
Mailing Address - Phone:703-625-5382
Mailing Address - Fax:
Practice Address - Street 1:9300 NW 21ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-6619
Practice Address - Country:US
Practice Address - Phone:360-313-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 19834235Z00000X
WA60540089235Z00000X
OR516385B235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist