Provider Demographics
NPI:1801185152
Name:HERNANDEZ, MARISSA ELENA
Entity Type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:ELENA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 S 155TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2906
Mailing Address - Country:US
Mailing Address - Phone:602-502-9225
Mailing Address - Fax:
Practice Address - Street 1:2432 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4726
Practice Address - Country:US
Practice Address - Phone:602-626-8851
Practice Address - Fax:602-865-8020
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA68382355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant