Provider Demographics
NPI:1942534623
Name:PERI, MARINA (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PERI
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 SANBORN ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3043
Mailing Address - Country:US
Mailing Address - Phone:847-502-4909
Mailing Address - Fax:
Practice Address - Street 1:767 SANBORN ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3043
Practice Address - Country:US
Practice Address - Phone:847-502-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242001384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist