Provider Demographics
NPI:1699373464
Name:MARINOVICH, AYELET ARBUCKLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AYELET
Middle Name:ARBUCKLE
Last Name:MARINOVICH
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 1:1451 WESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5760
Mailing Address - Country:US
Mailing Address - Phone:650-839-3056
Mailing Address - Fax:
Practice Address - Street 1:1451 WESSEX AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5760
Practice Address - Country:US
Practice Address - Phone:650-839-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist