Provider Demographics
NPI:1396930046
Name:MARNERIS, CHRISTINE (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MARNERIS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STUART DR
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-8947
Mailing Address - Country:US
Mailing Address - Phone:815-939-3651
Mailing Address - Fax:
Practice Address - Street 1:1 STUART DR
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-8947
Practice Address - Country:US
Practice Address - Phone:815-939-3651
Practice Address - Fax:815-939-7236
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
147001113231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3417000004001Medicaid