Provider Demographics
NPI:1184040362
Name:BRUNNER, MARISA ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:ELIZABETH
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NORTH BRIDGE AVENUE SUITE 5
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:609-737-3006
Mailing Address - Fax:
Practice Address - Street 1:12 BORDEN ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07748-4100
Practice Address - Country:US
Practice Address - Phone:914-557-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00701300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist