Provider Demographics
NPI:1508543026
Name:NGUYEN, MARISSA SLOANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:SLOANE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:SLOANE
Other - Last Name:SCHUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:6923 LOOKOUT CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5298
Mailing Address - Country:US
Mailing Address - Phone:513-377-2007
Mailing Address - Fax:
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-496-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist