Provider Demographics
NPI:1851901011
Name:CISMAS, MARINE NELLY (AUD)
Entity Type:Individual
Prefix:
First Name:MARINE
Middle Name:NELLY
Last Name:CISMAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:604-406-8811
Mailing Address - Fax:602-406-8810
Practice Address - Street 1:2910 N 3RD AVE STE 330
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4434
Practice Address - Country:US
Practice Address - Phone:604-406-8811
Practice Address - Fax:602-406-8810
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA12485231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist