Provider Demographics
NPI:1891813705
Name:MARINO, ANNE JEAN (SLP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:JEAN
Last Name:MARINO
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 1:16464 AVENIDA VENUSTO
Mailing Address - Street 2:APT F
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3263
Mailing Address - Country:US
Mailing Address - Phone:858-451-1343
Mailing Address - Fax:
Practice Address - Street 1:11770 BERNARDO PLAZA CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2422
Practice Address - Country:US
Practice Address - Phone:858-451-2790
Practice Address - Fax:858-451-2790
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASLP 7026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist