Provider Demographics
NPI:1629625439
Name:GILGER, MARISSA MAE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:MAE
Last Name:GILGER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 SUTTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4102
Mailing Address - Country:US
Mailing Address - Phone:530-477-8114
Mailing Address - Fax:530-477-1513
Practice Address - Street 1:1761 BROADWAY ST STE 200
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2227
Practice Address - Country:US
Practice Address - Phone:707-645-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3451237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter