Provider Demographics
NPI:1417574310
Name:MARZOL, ALYSSA JORDAN
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JORDAN
Last Name:MARZOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4240
Mailing Address - Country:US
Mailing Address - Phone:864-607-3871
Mailing Address - Fax:
Practice Address - Street 1:2398 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4240
Practice Address - Country:US
Practice Address - Phone:864-607-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist