Provider Demographics
NPI:1710199369
Name:MARZZACCO, CHRISTY L (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:L
Last Name:MARZZACCO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E MINER ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-3124
Mailing Address - Country:US
Mailing Address - Phone:610-938-9000
Mailing Address - Fax:610-938-9886
Practice Address - Street 1:200 YALE AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1918
Practice Address - Country:US
Practice Address - Phone:610-938-9000
Practice Address - Fax:610-938-9886
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL008759OtherLIC # SPEECH LANGUAGE