Provider Demographics
NPI:1417342619
Name:ANSEL, MARIANNE KLOTZ (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:KLOTZ
Last Name:ANSEL
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 1:6 JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1000
Mailing Address - Country:US
Mailing Address - Phone:914-661-9316
Mailing Address - Fax:845-429-7204
Practice Address - Street 1:6 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1000
Practice Address - Country:US
Practice Address - Phone:914-661-9316
Practice Address - Fax:845-429-7204
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006931-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03555180Medicaid