Provider Demographics
NPI:1629363114
Name:FERRISS, MARISOL (SLP)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:FERRISS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 NE 25TH ST APT 813
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5077
Mailing Address - Country:US
Mailing Address - Phone:305-467-7686
Mailing Address - Fax:
Practice Address - Street 1:162 NE 25TH ST APT 813
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5077
Practice Address - Country:US
Practice Address - Phone:305-467-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty