Provider Demographics
NPI:1356591218
Name:WENGRYN, MARISA I (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:I
Last Name:WENGRYN
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1735
Mailing Address - Country:US
Mailing Address - Phone:302-645-6686
Mailing Address - Fax:
Practice Address - Street 1:1270 KINGS HWY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1735
Practice Address - Country:US
Practice Address - Phone:302-645-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO10001080235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist