Provider Demographics
NPI:1497394639
Name:ISHKANIAN, MARISA
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:ISHKANIAN
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 1:108 ERIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2223
Mailing Address - Country:US
Mailing Address - Phone:518-366-2133
Mailing Address - Fax:
Practice Address - Street 1:108 ERIE BLVD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2223
Practice Address - Country:US
Practice Address - Phone:518-366-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0069721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist