Provider Demographics
NPI:1437582087
Name:MORANO, NINA LUISA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:LUISA
Last Name:MORANO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:LUISA
Other - Last Name:CLEMENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:6260 E PORTIA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1585
Mailing Address - Country:US
Mailing Address - Phone:203-928-7607
Mailing Address - Fax:
Practice Address - Street 1:5358 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4716
Practice Address - Country:US
Practice Address - Phone:480-699-9624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP9266235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist