Provider Demographics
NPI:1467574053
Name:MARASCO, KENDRA L (NYSLIC SLP,AUDIOLOG)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:L
Last Name:MARASCO
Suffix:
Gender:F
Credentials:NYSLIC SLP,AUDIOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3584
Mailing Address - Country:US
Mailing Address - Phone:585-223-5090
Mailing Address - Fax:585-425-1785
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3584
Practice Address - Country:US
Practice Address - Phone:585-223-5090
Practice Address - Fax:585-425-1785
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000303-1231HA2400X, 231HA2500X, 231H00000X, 237600000X
NY1751-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter