Provider Demographics
NPI:1558023432
Name:SIMON, MARISSA H (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:H
Last Name:SIMON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BALTIMORE PIKE STE 210
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1372
Mailing Address - Country:US
Mailing Address - Phone:484-227-7999
Mailing Address - Fax:
Practice Address - Street 1:1020 BALTIMORE PIKE STE 210
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1372
Practice Address - Country:US
Practice Address - Phone:484-227-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL016015OtherASHA