Provider Demographics
NPI:1558393942
Name:MARMOL, GISSEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GISSEL
Middle Name:
Last Name:MARMOL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 TURTLE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4266
Mailing Address - Country:US
Mailing Address - Phone:863-529-6068
Mailing Address - Fax:
Practice Address - Street 1:3310 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1974
Practice Address - Country:US
Practice Address - Phone:863-802-6600
Practice Address - Fax:863-802-6639
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12458235Z00000X
FLSI12502355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000000000OtherINFANTS AND YOUNG CHILDREN