Provider Demographics
NPI:1750088258
Name:STANKUS, MARLENE LEE (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:LEE
Last Name:STANKUS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MISS
Other - First Name:MARLENE
Other - Middle Name:LEE
Other - Last Name:WOLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:93 TERRAPIN LN
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1368
Mailing Address - Country:US
Mailing Address - Phone:609-306-7109
Mailing Address - Fax:
Practice Address - Street 1:93 TERRAPIN LN
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1368
Practice Address - Country:US
Practice Address - Phone:609-577-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00070900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist