Provider Demographics
NPI:1497964357
Name:BIANCUZZO, MARJORIE BETH (SLP MS,CCC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:BETH
Last Name:BIANCUZZO
Suffix:
Gender:F
Credentials:SLP MS,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COX CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-4427
Mailing Address - Country:US
Mailing Address - Phone:401-316-4146
Mailing Address - Fax:
Practice Address - Street 1:2 COX CT
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-4427
Practice Address - Country:US
Practice Address - Phone:401-316-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist