Provider Demographics
NPI:1497298269
Name:MARCELINO, DAKILA
Entity Type:Individual
Prefix:
First Name:DAKILA
Middle Name:
Last Name:MARCELINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1725
Mailing Address - Country:US
Mailing Address - Phone:712-789-0924
Mailing Address - Fax:
Practice Address - Street 1:3705 CHANDLER RD W
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-1123
Practice Address - Country:US
Practice Address - Phone:402-734-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist