Provider Demographics
NPI:1639316425
Name:KRAMER, MARISSA R (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:R
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 ANDOVER TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3719
Mailing Address - Country:US
Mailing Address - Phone:201-566-1071
Mailing Address - Fax:
Practice Address - Street 1:66 ANDOVER TER
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3719
Practice Address - Country:US
Practice Address - Phone:201-566-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016299-1235Z00000X
NJ41YS0073700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist