Provider Demographics
NPI:1750411955
Name:GRIFFITH, MARNI S (MHC, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:S
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MHC, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 E GOLF RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3438
Mailing Address - Country:US
Mailing Address - Phone:847-573-8548
Mailing Address - Fax:847-573-8528
Practice Address - Street 1:592 E GOLF RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3438
Practice Address - Country:US
Practice Address - Phone:847-573-8548
Practice Address - Fax:847-573-8528
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMD89830201POtherEARLY INTERVENTION PROVID