Provider Demographics
NPI:1700039344
Name:MARCLEY, CHRISTINA ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ANN
Last Name:MARCLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:RUGGIANO-MARCLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:65 TENNIS COURT LN
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1216
Mailing Address - Country:US
Mailing Address - Phone:914-603-3264
Mailing Address - Fax:
Practice Address - Street 1:65 TENNIS COURT LN
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1216
Practice Address - Country:US
Practice Address - Phone:914-603-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009933OtherCHRISTINA ANN RUGGIANO-MARCLEY, MA, CCC-SLP, TSHH