Provider Demographics
NPI:1740235456
Name:BODAPATY, MARNIE ALISSA (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MARNIE
Middle Name:ALISSA
Last Name:BODAPATY
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MS
Other - First Name:MARNIE
Other - Middle Name:ALISSA
Other - Last Name:ETKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:121 LOS ROBLES ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6720
Mailing Address - Country:US
Mailing Address - Phone:716-862-6096
Mailing Address - Fax:716-862-7816
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-6096
Practice Address - Fax:716-862-7816
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001361-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist