Provider Demographics
NPI:1598063836
Name:KANNER, MARIJANE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARIJANE
Middle Name:
Last Name:KANNER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MJ
Other - Middle Name:
Other - Last Name:ANCOWITZ KANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:3130 NETHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3416
Mailing Address - Country:US
Mailing Address - Phone:917-796-3366
Mailing Address - Fax:
Practice Address - Street 1:3130 NETHERLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3416
Practice Address - Country:US
Practice Address - Phone:917-796-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008205-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist