Provider Demographics
NPI:1649797127
Name:HATHAWAY, MARINA LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:LYNN
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:LYNN
Other - Last Name:POGGIALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6019 CONNEAUT LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-3817
Mailing Address - Country:US
Mailing Address - Phone:419-202-3432
Mailing Address - Fax:
Practice Address - Street 1:3714 CAMPBELL ST STE B
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7232
Practice Address - Country:US
Practice Address - Phone:419-625-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist