Provider Demographics
NPI:1598166555
Name:STELLA, MARISA (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:
Last Name:STELLA
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LOMBARDO DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2730
Mailing Address - Country:US
Mailing Address - Phone:570-760-7502
Mailing Address - Fax:
Practice Address - Street 1:245 OLD LAKE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-3154
Practice Address - Country:US
Practice Address - Phone:570-639-1885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005258L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist