Provider Demographics
NPI:1710139886
Name:MARIANNE K. ANSEL SPEECH PATHOLOGY PC
Entity Type:Organization
Organization Name:MARIANNE K. ANSEL SPEECH PATHOLOGY PC
Other - Org Name:MJM SPEECH THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:KLOTZ
Authorized Official - Last Name:ANSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:914-661-9316
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-0243
Mailing Address - Country:US
Mailing Address - Phone:914-661-9316
Mailing Address - Fax:845-429-7204
Practice Address - Street 1:6 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1000
Practice Address - Country:US
Practice Address - Phone:914-661-9316
Practice Address - Fax:845-429-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006931-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency