Provider Demographics
NPI:1942364526
Name:BASKIN, MARINA (SLP)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:BASKIN
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 1:5217 ETIWANDA AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4335
Mailing Address - Country:US
Mailing Address - Phone:818-287-8875
Mailing Address - Fax:818-704-7898
Practice Address - Street 1:5217 ETIWANDA AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4335
Practice Address - Country:US
Practice Address - Phone:818-287-8875
Practice Address - Fax:818-704-7898
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist