Provider Demographics
NPI:1689694622
Name:MARINI, MONICA (BC-HIS,ACA)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:MARINI
Suffix:
Gender:F
Credentials:BC-HIS,ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7017 S WESTNEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-4206
Mailing Address - Country:US
Mailing Address - Phone:269-342-0810
Mailing Address - Fax:
Practice Address - Street 1:7017 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4206
Practice Address - Country:US
Practice Address - Phone:269-342-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002374237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689694622Medicaid
MI640Z911880OtherBCBS MICHIGAN